Provider Demographics
NPI:1922859784
Name:HASKINS, MYCHENEL J
Entity Type:Individual
Prefix:
First Name:MYCHENEL
Middle Name:J
Last Name:HASKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17325 EUCLID AVE STE 2040
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1250
Mailing Address - Country:US
Mailing Address - Phone:216-208-0627
Mailing Address - Fax:
Practice Address - Street 1:17325 EUCLID AVE STE 2040
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1250
Practice Address - Country:US
Practice Address - Phone:216-312-7678
Practice Address - Fax:216-208-0627
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator