Provider Demographics
NPI:1700284387
Name:KRETZSCHMAR - MOUNCEY, KIRSTI (LISW-S, LCDCIII)
Entity type:Individual
Prefix:MRS
First Name:KIRSTI
Middle Name:
Last Name:KRETZSCHMAR - MOUNCEY
Suffix:
Gender:F
Credentials:LISW-S, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 SUPERIOR AVE E
Mailing Address - Street 2:# 1400
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1902
Mailing Address - Country:US
Mailing Address - Phone:216-619-6194
Mailing Address - Fax:216-619-6194
Practice Address - Street 1:526 SUPERIOR AVE E
Practice Address - Street 2:# 1400
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-1902
Practice Address - Country:US
Practice Address - Phone:216-619-6194
Practice Address - Fax:216-619-6194
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 07002121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical