Basic Information
| Provider Information | |||||||||
| NPI: | 1376715060 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALCORN | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | MSSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6000 W CREEK RD | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441312139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002232273 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9500 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164442200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2008 | ||||||||
| LastUpdateDate: | 05/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | I0005166 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.