Provider Demographics
NPI:1891305900
Name:CHERAVITCH, AMANDA MARGARET
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARGARET
Last Name:CHERAVITCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16545 FIRWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-5143
Mailing Address - Country:US
Mailing Address - Phone:440-708-4195
Mailing Address - Fax:
Practice Address - Street 1:9930 JOHNNYCAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6752
Practice Address - Country:US
Practice Address - Phone:440-579-5100
Practice Address - Fax:440-579-5104
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2404816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty