Provider Demographics
NPI:1811336365
Name:GADELSAYED, TANA R (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:TANA
Middle Name:R
Last Name:GADELSAYED
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 1:10622 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRATENAHL
Mailing Address - State:OH
Mailing Address - Zip Code:44108-1017
Mailing Address - Country:US
Mailing Address - Phone:216-223-8530
Mailing Address - Fax:
Practice Address - Street 1:2101 RICHMOND RD STE 1005
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1390
Practice Address - Country:US
Practice Address - Phone:216-223-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.16001021041C0700X
NY72 084030104100000X
OHS.0900942104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker