Provider Demographics
NPI:1215755186
Name:FRONTERA, CHRISTIAN JOSEPH (MSW LSW)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JOSEPH
Last Name:FRONTERA
Suffix:
Gender:M
Credentials:MSW LSW
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:JOSEPH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11003 CLIFTON BLVD APT 5
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1570
Mailing Address - Country:US
Mailing Address - Phone:814-779-9551
Mailing Address - Fax:
Practice Address - Street 1:10427 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-1645
Practice Address - Country:US
Practice Address - Phone:216-521-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2411499104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker