Provider Demographics
NPI:1992596761
Name:THOMAS, STEPHANIE K (CPRS)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:K
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4843 WENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1167
Mailing Address - Country:US
Mailing Address - Phone:440-552-4442
Mailing Address - Fax:
Practice Address - Street 1:4843 WENDELL AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1167
Practice Address - Country:US
Practice Address - Phone:440-552-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801415101Y00000X
OHAPS.006167101YP2500X
OHS.0027920104100000X
OHCDCA.182348101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker