Provider Demographics
NPI:1285416404
Name:HERCEG, ALLISON (SOCIAL WORKER TRANEE)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:HERCEG
Suffix:
Gender:F
Credentials:SOCIAL WORKER TRANEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7911 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2815
Mailing Address - Country:US
Mailing Address - Phone:216-334-2876
Mailing Address - Fax:216-334-2882
Practice Address - Street 1:602 SOUTH ST STE D1
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1499
Practice Address - Country:US
Practice Address - Phone:440-285-3537
Practice Address - Fax:216-334-2882
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2303139-TRNE104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker