Provider Demographics
NPI:1912482597
Name:LENTZ, ELENA MARIE
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:MARIE
Last Name:LENTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 ROCKSIDE WOODS BLVD N STE 310
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2343
Mailing Address - Country:US
Mailing Address - Phone:216-525-1885
Mailing Address - Fax:
Practice Address - Street 1:1900 E 30TH ST APT 208
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-4601
Practice Address - Country:US
Practice Address - Phone:440-413-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1803052104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker