Provider Demographics
NPI:1952455149
Name:ALI-HASSAN, CARLIE CHAPMAN (MSSA, LISW)
Entity Type:Individual
Prefix:MS
First Name:CARLIE
Middle Name:CHAPMAN
Last Name:ALI-HASSAN
Suffix:
Gender:F
Credentials:MSSA, LISW
Other - Prefix:MS
Other - First Name:CARLIE
Other - Middle Name:ANNE
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3315 AVALON RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3407
Mailing Address - Country:US
Mailing Address - Phone:216-410-0242
Mailing Address - Fax:
Practice Address - Street 1:4255 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND HILLS
Practice Address - State:OH
Practice Address - Zip Code:44128-2811
Practice Address - Country:US
Practice Address - Phone:216-292-9700
Practice Address - Fax:216-292-9721
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00314761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0028740Medicaid