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NPI Code Detail

MEDICARE: JANE LEWIS LISW

MEDICARE: JANE LEWIS LISW
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
1104100000XSocial WorkerS1000313OH

General Provider Information

NPI Number : 1083908719
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE LEWIS LISW
Provider Business Mailing Address
First Line : 30800 CHAGRIN BLVD
Second Line :
City : CLEVELAND
State : OH
Zip : 44124-5925
Country : US
Telephone Number : 216-591-0324
Fax Number : 216-591-1243
Provider Business Practice Location Address
First Line : 30800 CHAGRIN BLVD
Second Line :
City : CLEVELAND
State : OH
Zip : 44124-5925
Country : US
Telephone Number : 216-591-0324
Fax Number : 216-591-1243
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2011
Last Update Date : 11/01/2016

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