Provider Demographics
NPI:1538256128
Name:REDMON, STEFANIE LARANETTE (MSW)
Entity type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:LARANETTE
Last Name:REDMON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:STEFANIE
Other - Middle Name:LARANETTE
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4240 E 163RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2406
Mailing Address - Country:US
Mailing Address - Phone:216-921-6002
Mailing Address - Fax:216-921-6002
Practice Address - Street 1:10000 BRECKSVILLE RD BLDG 5
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-3204
Practice Address - Country:US
Practice Address - Phone:440-526-3030
Practice Address - Fax:440-546-2760
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW0000006628104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker