Provider Demographics
NPI:1922040146
Name:WABEKE, TODD A (LISW)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:WABEKE
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6929 W 130TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7878
Mailing Address - Country:US
Mailing Address - Phone:440-842-6867
Mailing Address - Fax:440-842-8914
Practice Address - Street 1:6929 W 130TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7878
Practice Address - Country:US
Practice Address - Phone:440-842-6867
Practice Address - Fax:440-842-8914
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9534101Y00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker