Provider Demographics
NPI:1760428585
Name:GIMBEN, ELIZABETH KATHY (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KATHY
Last Name:GIMBEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24800 HIGHPOINT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6041
Mailing Address - Country:US
Mailing Address - Phone:216-831-6611
Mailing Address - Fax:216-831-2726
Practice Address - Street 1:25111 COUNTRY CLUB BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-5345
Practice Address - Country:US
Practice Address - Phone:440-614-2520
Practice Address - Fax:440-614-2526
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7204101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW24736Medicare PIN