Provider Demographics
NPI:1861799942
Name:BAUS, IRENE (LISW-S)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:BAUS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE RD.
Mailing Address - Street 2:STE 303
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3424
Mailing Address - Country:US
Mailing Address - Phone:440-387-8907
Mailing Address - Fax:
Practice Address - Street 1:20525 CENTER RIDGE RD.
Practice Address - Street 2:STE 303
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3424
Practice Address - Country:US
Practice Address - Phone:440-387-8907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1001012-TRNE1041C0700X
OHI.1500268-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid