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NPI Code Detail

MEDICARE: SAMANTHA ANN MISHNE MSW, LISW-S

MEDICARE: SAMANTHA ANN MISHNE MSW, LISW-S
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
11041C0700XClinical Social WorkerI-0009299OH

General Provider Information

NPI Number : 1124061395
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA ANN MISHNE MSW, LISW-S
Provider Business Mailing Address
First Line : 19910 MALVERN RD STE 217
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44122-2823
Country : US
Telephone Number : 216-513-0192
Fax Number :
Provider Business Practice Location Address
First Line : 19910 MALVERN RD STE 217
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44122-2823
Country : US
Telephone Number : 216-513-0192
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 01/01/2026

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