Provider Demographics
NPI:1306245196
Name:BUCKNER, ASHAY MONAE (LISW)
Entity type:Individual
Prefix:MRS
First Name:ASHAY
Middle Name:MONAE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:ASHAY
Other - Middle Name:MONAE
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASHAY MONAE PRATT
Mailing Address - Street 1:1536 SAINT CLAIR AVE NE # S19
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2004
Mailing Address - Country:US
Mailing Address - Phone:216-990-4569
Mailing Address - Fax:
Practice Address - Street 1:1536 SAINT CLAIR AVE NE # S19
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114
Practice Address - Country:US
Practice Address - Phone:216-220-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1450710104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid