Basic Information
| Provider Information | |||||||||
| NPI: | 1700347291 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAY | ||||||||
| FirstName: | AIMEE | ||||||||
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| Credential: | LSW, LCDCIII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12501 EASTWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | GARFIELD HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441253906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163137100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4269 PEARL RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441094234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164314131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2019 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 168648 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | S.2106916 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 168648 | 01 | OH | OCDP | OTHER | 162265 | 01 | OH | OCDP | OTHER | 2106919 | 01 | OH | CSWMFTB | OTHER |