Provider Demographics
NPI:1285715961
Name:PRIESTER, JAMES WILLIAM (LISW LISWS PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:PRIESTER
Suffix:
Gender:M
Credentials:LISW LISWS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 LAKE AVE
Mailing Address - Street 2:SUITE 2613
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1576
Mailing Address - Country:US
Mailing Address - Phone:216-258-8838
Mailing Address - Fax:216-228-9686
Practice Address - Street 1:30400 DETROIT RD
Practice Address - Street 2:STE 301
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:216-258-8838
Practice Address - Fax:216-228-9686
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00034681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW21573Medicare PIN