Provider Demographics
NPI:1730693664
Name:LAW, ELENA (LSW)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:SANKOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27150 MALLARD AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1519
Mailing Address - Country:US
Mailing Address - Phone:216-309-9312
Mailing Address - Fax:
Practice Address - Street 1:8411 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-3932
Practice Address - Country:US
Practice Address - Phone:216-411-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH162144101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)