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NPI Code Detail

MEDICARE: MR. JEFFREY SCOTT ALLEN LISW-S, LICDC-CS

MEDICARE: MR. JEFFREY SCOTT ALLEN LISW-S, LICDC-CS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.976101OH
21041C0700XClinical Social WorkerI.0007541-SUPVOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396822052
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY SCOTT ALLEN LISW-S, LICDC-CS
Provider Business Mailing Address
First Line : 246 NORTHLAND DR
Second Line : STE 200A
City : MEDINA
State : OH
Zip : 44256-3440
Country : US
Telephone Number : 330-452-9812
Fax Number : 330-430-1288
Provider Business Practice Location Address
First Line : 246 NORTHLAND DR
Second Line :
City : MEDINA
State : OH
Zip : 44256-3441
Country : US
Telephone Number : 330-725-9195
Fax Number : 330-725-9187
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 03/03/2020

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Directions to “ MR. JEFFREY SCOTT ALLEN LISW-S, LICDC-CS” Practice Location

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