MEDICARE: KARRYL JOYCE LINDSEY LISW-S, LICDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	872393	OH
2	1041C0700X	Clinical Social Worker	I0008328-S	OH

General Provider Information

NPI Number	:	1053576157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARRYL JOYCE LINDSEY LISW-S, LICDC

Provider Business Mailing Address
First Line	:	5311 NORTHFIELD RD
Second Line	:	SUITE 409
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-1135
Country	:	US
Telephone Number	:	216-518-9250
Fax Number	:	216-518-9254

Provider Business Practice Location Address
First Line	:	5311 NORTHFIELD RD
Second Line	:
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-1135
Country	:	US
Telephone Number	:	216-518-9250
Fax Number	:	216-518-9254

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

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	07/28/2008

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