Provider Demographics
NPI:1770661100
Name:SLATTERY, JAMES CHARLES (LSW CDCA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CHARLES
Last Name:SLATTERY
Suffix:
Gender:M
Credentials:LSW CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 PINEBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-2587
Mailing Address - Country:US
Mailing Address - Phone:330-945-4046
Mailing Address - Fax:
Practice Address - Street 1:405 TALLMADGE RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3362
Practice Address - Country:US
Practice Address - Phone:330-907-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS31088104100000X
OH071019101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1821184326OtherCLEVELAND CLINIC AKRON GENERAL REHABILITIATION HOSPITAL