Provider Demographics
NPI:1538265475
Name:CYBULSKI, TERESE MARIE (LISW)
Entity type:Individual
Prefix:MRS
First Name:TERESE
Middle Name:MARIE
Last Name:CYBULSKI
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W 46TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6916
Mailing Address - Country:US
Mailing Address - Phone:866-363-6611
Mailing Address - Fax:440-997-4282
Practice Address - Street 1:24800 HIGHPOINT RD
Practice Address - Street 2:SUITE B
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-6052
Practice Address - Country:US
Practice Address - Phone:866-363-6611
Practice Address - Fax:216-831-2726
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00023031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical