Provider Demographics
NPI:1992980585
Name:BYRD, CHARLES R (LISW)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:BYRD
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 HOUGH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-4247
Mailing Address - Country:US
Mailing Address - Phone:216-231-7700
Mailing Address - Fax:216-231-7920
Practice Address - Street 1:13301 MILES AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-5521
Practice Address - Country:US
Practice Address - Phone:216-751-3100
Practice Address - Fax:216-751-2480
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00044641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH438120Medicare PIN