Provider Demographics
NPI:1811328404
Name:EMRICH, MARY LEE (LSW, LPCC-S, LICDC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LEE
Last Name:EMRICH
Suffix:
Gender:F
Credentials:LSW, LPCC-S, LICDC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LEE
Other - Last Name:MIRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LSW
Mailing Address - Street 1:23875 COMMERCE PARK STE 365
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5835
Mailing Address - Country:US
Mailing Address - Phone:216-532-3427
Mailing Address - Fax:216-502-2803
Practice Address - Street 1:20525 CENTER RIDGE RD
Practice Address - Street 2:STE 365
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3437
Practice Address - Country:US
Practice Address - Phone:866-466-9591
Practice Address - Fax:216-712-6313
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0901461104100000X
OHC1100601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker