Provider Demographics
NPI:1427719988
Name:THOMAS, CHRYSTENE (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:CHRYSTENE
Middle Name:
Last Name:THOMAS
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 1:3480 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-2105
Mailing Address - Country:US
Mailing Address - Phone:216-577-5790
Mailing Address - Fax:
Practice Address - Street 1:3480 W 151ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-2105
Practice Address - Country:US
Practice Address - Phone:216-577-5790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1100857-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical