Provider Demographics
NPI:1750630018
Name:HARRELSON, PATRICIA ANN (LISW-S)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:HARRELSON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9303 MASON RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44814-9493
Mailing Address - Country:US
Mailing Address - Phone:216-409-2525
Mailing Address - Fax:
Practice Address - Street 1:5508 MONROE ST
Practice Address - Street 2:SUITE #2
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2268
Practice Address - Country:US
Practice Address - Phone:216-409-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0800351-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker