MEDICARE: MARY K LAWRENCE 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.2304596	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1457046161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY K LAWRENCE LISW-S

Provider Business Mailing Address
First Line	:	PO BOX 18126
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-0126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3170 ESSEX RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3538
Country	:	US
Telephone Number	:	330-274-4118
Fax Number	:

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

Provider Enumeration Date	:	04/07/2023
Last Update Date	:	07/31/2025

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