Provider Demographics
NPI:1487162681
Name:GERHARDT, LORETTA IRMENGARDIS (LSW, CDCA)
Entity type:Individual
Prefix:MISS
First Name:LORETTA
Middle Name:IRMENGARDIS
Last Name:GERHARDT
Suffix:
Gender:F
Credentials:LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3407
Mailing Address - Country:US
Mailing Address - Phone:216-631-4741
Mailing Address - Fax:216-631-2379
Practice Address - Street 1:3135 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3407
Practice Address - Country:US
Practice Address - Phone:216-631-4741
Practice Address - Fax:216-631-2379
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH080213101YA0400X
OHS.00178021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)