Provider Demographics
NPI:1992058267
Name:GOLDURS, YVETTE (LISW-S)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:GOLDURS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3867 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1649
Mailing Address - Country:US
Mailing Address - Phone:216-526-4208
Mailing Address - Fax:216-274-6388
Practice Address - Street 1:20575 CENTER RIDGE RD STE 119
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3422
Practice Address - Country:US
Practice Address - Phone:216-526-4208
Practice Address - Fax:216-274-6388
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-54101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical