MEDICARE: ALAN D WANGER 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	104100000X	Social Worker	S.2208513	OH

General Provider Information

NPI Number	:	1144043878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN D WANGER LSW

Provider Business Mailing Address
First Line	:	12160 TRISKETT RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-2548
Country	:	US
Telephone Number	:	216-926-9739
Fax Number	:

Provider Business Practice Location Address
First Line	:	20611 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44117-1521
Country	:	US
Telephone Number	:	216-859-2710
Fax Number	:

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

Provider Enumeration Date	:	11/01/2024
Last Update Date	:	11/01/2024

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Directions to “ ALAN D WANGER LSW” Practice Location

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