Provider Demographics
NPI:1215468335
Name:KARABANOVS, KIRA L (LISW-S)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:L
Last Name:KARABANOVS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6090 MIDDLEBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-3220
Mailing Address - Country:US
Mailing Address - Phone:216-470-7025
Mailing Address - Fax:
Practice Address - Street 1:21430 LORAIN RD STE 110
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44126-2148
Practice Address - Country:US
Practice Address - Phone:216-302-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1501127-SUPV1041S0200X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool