Provider Demographics
NPI:1700342177
Name:SEWARD, KEITH O (CDCA)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:O
Last Name:SEWARD
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 NORTHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HT
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3737
Mailing Address - Country:US
Mailing Address - Phone:216-470-7937
Mailing Address - Fax:
Practice Address - Street 1:3746 PROSPECT AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2706
Practice Address - Country:US
Practice Address - Phone:216-391-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.169227101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCDCA.169227OtherCDCA