Provider Demographics
NPI:1700335114
Name:FAHEY, PATRICIA (LISW-S)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:FAHEY
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25540 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2612
Mailing Address - Country:US
Mailing Address - Phone:216-732-3444
Mailing Address - Fax:216-732-3455
Practice Address - Street 1:25540 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2612
Practice Address - Country:US
Practice Address - Phone:216-732-3444
Practice Address - Fax:216-732-3455
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00072591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical