Provider Demographics
NPI:1942410998
Name:SHOFAR, CRISTIAN N (PCC-S)
Entity Type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:N
Last Name:SHOFAR
Suffix:
Gender:M
Credentials:PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 MARS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5832
Mailing Address - Country:US
Mailing Address - Phone:440-382-2817
Mailing Address - Fax:216-228-1610
Practice Address - Street 1:14701 DETROIT AVE
Practice Address - Street 2:SUITE 775
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4115
Practice Address - Country:US
Practice Address - Phone:440-382-2817
Practice Address - Fax:216-228-1610
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE. 0500421101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health