Provider Demographics
NPI:1205884731
Name:KAYE, ELLEN (LISW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:KAYE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20600 CHAGRIN BLVD STE 620
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5340
Mailing Address - Country:US
Mailing Address - Phone:216-548-7850
Mailing Address - Fax:305-891-9647
Practice Address - Street 1:20600 CHAGRIN BLVD STE 620
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5340
Practice Address - Country:US
Practice Address - Phone:216-548-7850
Practice Address - Fax:216-751-5894
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 81981041C0700X
OHI.1000313-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical