Provider Demographics
NPI:1780240317
Name:OPATRNY, ALEXANDRA (LSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:OPATRNY
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7285 PLAYERS CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-8943
Mailing Address - Country:US
Mailing Address - Phone:440-537-3563
Mailing Address - Fax:
Practice Address - Street 1:23293 COMMERCE PARK STE A
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5808
Practice Address - Country:US
Practice Address - Phone:216-292-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2310209104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2910854Medicaid