NPIMap

Organization Active NPI

Cleveland Sex & Intimacy Counseling

  • Clinical Social Worker
  • Cleveland, OH
National Provider Identifier
1982203246
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
CLEVELAND SEX & INTIMACY COUNSELING
Practice address
3500 Lorain Ave Ste 301
Cleveland, OH 44113-3726
Phone
(216) 250-1607
Fax
(216) 304-6669
NPI assigned
Oct 19, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly A Fuller, PH.D., LISW-SNPI 1083053375
Title
Ceo
Phone
(440) 823-6010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

3500 Lorain Ave Ste 301
Cleveland, OH 44113-3726

Mailing address

3500 Lorain Ave Ste 301
Cleveland, OH 44113-3726
Phone (216) 250-1607

Other identifiers 1

IdentifierTypeStateIssuer
1083053375MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210625002716 OH Part B Supplier - Clinic/Group Practice 5890196968 Receives reassigned benefits from 6 practitioners
Practice locations: Cleveland, OH

National Provider Directory

National Provider Directory

Locations

3500 Lorain Ave
Ste 407
Cleveland, OH 44113
Phone (216) 200-8543

3500 Lorain Ave
Ste 301
Cleveland, OH 44113
Phone (216) 250-1607

6600 Lorain Ave
Unit 602422
Cleveland, OH 44102

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1982203246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 LORAIN AVE STE 301",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441133726",
            "telephone_number": "216-250-1607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 LORAIN AVE STE 301",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441133726",
            "telephone_number": "216-250-1607",
            "fax_number": "216-304-6669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEVELAND SEX & INTIMACY COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-19",
        "last_updated": "2023-09-06",
        "certification_date": "2021-12-03",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "440-823-6010",
        "authorized_official_credential": "PH.D., LISW-S"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083053375",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.