Provider Demographics
NPI:1962281873
Name:SEARS, LAVONTE
Entity type:Individual
Prefix:
First Name:LAVONTE
Middle Name:
Last Name:SEARS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 E 173RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-2931
Mailing Address - Country:US
Mailing Address - Phone:216-703-0119
Mailing Address - Fax:
Practice Address - Street 1:1470 E 173RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-2931
Practice Address - Country:US
Practice Address - Phone:216-703-0119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No376J00000XNursing Service Related ProvidersHomemaker