Provider Demographics
NPI:1023564846
Name:SGRO, RACHEL (MSW, LSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SGRO
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LYNN
Other - Last Name:FAHEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:5919 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-1673
Mailing Address - Country:US
Mailing Address - Phone:440-382-4287
Mailing Address - Fax:
Practice Address - Street 1:5919 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144-1673
Practice Address - Country:US
Practice Address - Phone:440-382-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0600725104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker