Provider Demographics
NPI:1821602566
Name:LENNON, PATRICK CASEY
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:CASEY
Last Name:LENNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13993 SWEETBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:NOVELTY
Mailing Address - State:OH
Mailing Address - Zip Code:44072-9716
Mailing Address - Country:US
Mailing Address - Phone:440-223-3682
Mailing Address - Fax:
Practice Address - Street 1:14707 S CHESHIRE ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:OH
Practice Address - Zip Code:44021-9601
Practice Address - Country:US
Practice Address - Phone:440-887-1100
Practice Address - Fax:440-887-1103
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
OHAPS.003500175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0416711Medicaid