Provider Demographics
NPI:1760697817
Name:DUDAS, LISA ADRIENNE (LISW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ADRIENNE
Last Name:DUDAS
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 1:14601 DETROIT AVE
Mailing Address - Street 2:SUITE #710
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4214
Mailing Address - Country:US
Mailing Address - Phone:216-227-2453
Mailing Address - Fax:216-227-2509
Practice Address - Street 1:14601 DETROIT AVE
Practice Address - Street 2:SUITE #710
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4214
Practice Address - Country:US
Practice Address - Phone:216-227-2453
Practice Address - Fax:216-227-2509
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI59631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical