Basic Information
| Provider Information | |||||||||
| NPI: | 1922482314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | GERMAINE | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18534 WINSLOW RD | ||||||||
| Address2: | |||||||||
| City: | SHAKER HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441224815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167722727 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3135 EUCLID AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441152531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163912030 | ||||||||
| FaxNumber: | 2163918946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2015 | ||||||||
| LastUpdateDate: | 07/15/2015 | ||||||||
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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 | 1041C0700X | S29235 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | S29235 | 01 | OH | LICENSE SOCIAL WORKER | OTHER |