MR. EMERSON LEE DOUGLAS (LISW) – Clinical Social Worker, NPI 1235780016

Clinical Social Worker

MR. EMERSON LEE DOUGLAS (LISW) is a healthcare provider. based in Mentor, Ohio. specializing in Clinical Social Worker. They hold the professional credentials LISW. They hold a License No. I.2002146 (OH). The NPI Number for MR. EMERSON LEE DOUGLAS (LISW) is 1235780016

Main info

Male

Sole Proprietor

9 Years Of Experience

Accepts Medicare Assignment

Name

MR. EMERSON LEE DOUGLAS (LISW)

NPI

1235780016

Phone

(440) 354-9924

Address

9220 MENTOR AVE

Enumeration Date

24 September 2019

Last Update Date

5 May 2020

Doctor Profile

Medical School Name

OTHER

Secondary Phone

4402551700

Graduation Year

2017 (9 years ago)

PAC ID

8325469141

Group Practice PAC ID

9638440241

Professional Enrollment ID

I20200603002543

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience36

Completeness75

Years active:6State licenses:1Digital endpointsOther names

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Provider Addresses for MR. EMERSON LEE DOUGLAS (LISW)

9220, Mentor Avenue, Mentor, Lake County, Ohio, 44060, United States
MENTOR, OH 440606412
Phone: (440) 354-9924
Fax: (833) 209-8465
Type: Mailing
30800, Chagrin Boulevard, Pepper Pike, Cuyahoga County, Ohio, 44124, United States
PEPPER PIKE, OH 441245925
Phone: (216) 591-0324
Fax: (216) 591-1243
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 44060)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 9638440241View full group profile

Name	Specialty	State
CHRISTINE VAVRO (MA, MSW, LISW)	-	OH
MISS LYLE J. MORRIS (LISW)	Clinical Social Worker	OH
CELISA MARIE HARDESTY (LISW)	-	OH
KELLEY L. PASTOR (PA-C)	Physician Assistant	OH
SYDNEY GRACE STEWART (CT)	Mental Health Counselor	OH
RICHARD SCHENKELBERG (M.D.)	P S Y C H I A T R Y	OH
PUSHPALATHA TIRUMALE VENKATARAMAN (PHYSICIAN ASSISTANT)	Physician Assistant	OH
MRS. ASHLEY MARIE EL-KHOURY (LPCC)	Mental Health Counselor	OH
SAMANTHA KISSIG	Clinical Social Worker	OH
Unknown Individual	-	OH