Provider Demographics
NPI:1962887133
Name:MULHOLLAND WALLACE, CLARE B (EED, LSW)
Entity type:Individual
Prefix:MS
First Name:CLARE
Middle Name:B
Last Name:MULHOLLAND WALLACE
Suffix:
Gender:F
Credentials:EED, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 DEEPWOOD BLVD
Mailing Address - Street 2:A 10
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8900
Mailing Address - Country:US
Mailing Address - Phone:440-391-9976
Mailing Address - Fax:
Practice Address - Street 1:1641 PAYNE AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2919
Practice Address - Country:US
Practice Address - Phone:216-987-8983
Practice Address - Fax:216-987-7883
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS08002271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical