Shawn Hardy, CDCA
Individual provider Active NPI Peer Specialist · Cleveland, OH
NPI 1356854574 · NPPES record last updated Nov 27, 2019
Key facts
- NPI
- 1356854574
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- Practice address
- 3622 Prospect Ave E
Cleveland, OH 44115-2704 - Phone
- (216) 431-4600
- NPI assigned
- Nov 9, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CDCA.165152 | OH | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Imex Inc | Addiction (Substance Use Disorder) | Past | Accepting new patients |
| Moore Counseling & Mediation Services, Inc. | Addiction (Substance Use Disorder) | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CDCA.165152 | OH | |
| Peer Specialist | 175T00000X | Yes |
Addresses
Primary practice location
3622 Prospect Ave E
Cleveland, OH 44115-2704
Mailing address
25 Severance Cir Apt 215
Cleveland Heights, OH 44118-1505
Phone (216) 256-5272
Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.