Provider Demographics
NPI:1972637007
Name:STEHLIK, LARRAINE FRICK (MSW,LISW,CCDCI)
Entity type:Individual
Prefix:MRS
First Name:LARRAINE
Middle Name:FRICK
Last Name:STEHLIK
Suffix:
Gender:F
Credentials:MSW,LISW,CCDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2615
Mailing Address - Country:US
Mailing Address - Phone:440-871-7634
Mailing Address - Fax:440-260-8331
Practice Address - Street 1:202 E BAGLEY RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-2058
Practice Address - Country:US
Practice Address - Phone:440-260-8297
Practice Address - Fax:440-260-8331
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI . 00100581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical