Provider Demographics
NPI:1861409559
Name:RESHOTKO, PAULA (LISW)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:
Last Name:RESHOTKO
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 1:3333 WARRENSVILLE CENTER RD APT 602
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3732
Mailing Address - Country:US
Mailing Address - Phone:216-991-7757
Mailing Address - Fax:
Practice Address - Street 1:23360 CHAGRIN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5547
Practice Address - Country:US
Practice Address - Phone:216-464-4454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI5661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical