Provider Demographics
NPI:1841994837
Name:MCLAUGHLIN, EDWARD THOMAS (DSP)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:THOMAS
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 BELLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2618
Mailing Address - Country:US
Mailing Address - Phone:216-575-8668
Mailing Address - Fax:
Practice Address - Street 1:21551 ROBINHOOD AVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2746
Practice Address - Country:US
Practice Address - Phone:216-575-8668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH385H00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care