Provider Demographics
NPI:1245822907
Name:MUNSHOWER, JEFFREY MARTIN
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARTIN
Last Name:MUNSHOWER
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 1:3719 DENISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-2691
Mailing Address - Country:US
Mailing Address - Phone:216-334-8951
Mailing Address - Fax:
Practice Address - Street 1:3719 DENISON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-2691
Practice Address - Country:US
Practice Address - Phone:216-334-8951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0002216175T00000X
OH179274101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist