Provider Demographics
NPI:1831428887
Name:JAMES, DESIREE (LISW)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11021 WADE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1819
Mailing Address - Country:US
Mailing Address - Phone:216-406-0175
Mailing Address - Fax:
Practice Address - Street 1:27801 EUCLID AVE # 454
Practice Address - Street 2:OMNI PARK OFFICE BUILDING
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3549
Practice Address - Country:US
Practice Address - Phone:216-406-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0090002891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical