Provider Demographics
NPI:1013425776
Name:SLADE, CHARLOTTE DREMA (MSW, LISW-S)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:DREMA
Last Name:SLADE
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 E 146TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-3729
Mailing Address - Country:US
Mailing Address - Phone:216-851-1853
Mailing Address - Fax:
Practice Address - Street 1:966 E 146TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-3729
Practice Address - Country:US
Practice Address - Phone:216-851-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI1312-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical