Provider Demographics
NPI:1174714604
Name:FAWCETT-DUBOW, KIRSTEN E (LISW-S)
Entity type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:E
Last Name:FAWCETT-DUBOW
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 1:2847 HAMPSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1614
Mailing Address - Country:US
Mailing Address - Phone:216-702-5056
Mailing Address - Fax:
Practice Address - Street 1:34305 SOLON RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2666
Practice Address - Country:US
Practice Address - Phone:440-349-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-88791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical