MEDICARE: ERIC LICHTENFELD LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	S.1802636	OH

General Provider Information

NPI Number	:	1033768098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC LICHTENFELD LSW

Provider Business Mailing Address
First Line	:	5123 NORWICH ST STE 110
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-1486
Country	:	US
Telephone Number	:	614-687-0068
Fax Number	:	844-272-9333

Provider Business Practice Location Address
First Line	:	145 W SCHROCK RD
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-2831
Country	:	US
Telephone Number	:	614-849-8204
Fax Number	:	844-272-9333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	09/11/2019

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