MEDICARE: TALLEY O'CONNOR MCMONAGLE 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
1	1041C0700X	Clinical Social Worker	I.2002143	OH

General Provider Information

NPI Number	:	1356915466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALLEY O'CONNOR MCMONAGLE LISW-S

Provider Business Mailing Address
First Line	:	1748 OAKMOUNT RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-4008
Country	:	US
Telephone Number	:	216-905-7179
Fax Number	:

Provider Business Practice Location Address
First Line	:	1748 OAKMOUNT RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-4008
Country	:	US
Telephone Number	:	216-905-7179
Fax Number	:

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

Provider Enumeration Date	:	05/14/2021
Last Update Date	:	05/14/2021

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Directions to “ TALLEY O'CONNOR MCMONAGLE LISW-S” Practice Location

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