Provider Demographics
NPI:1396041281
Name:HOLMES, SAUNDRA L (LISW)
Entity type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:L
Last Name:HOLMES
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:PO BOX 32323
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132
Mailing Address - Country:US
Mailing Address - Phone:216-346-0832
Mailing Address - Fax:
Practice Address - Street 1:24101 LAKE SHORE BLVD
Practice Address - Street 2:APT 814
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-4210
Practice Address - Country:US
Practice Address - Phone:216-831-2255
Practice Address - Fax:216-378-3906
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.11000591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid