MEDICARE: MR. RONALD COLUCCI LISW

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-2297	OH

General Provider Information

NPI Number	:	1487740387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD COLUCCI LISW

Provider Business Mailing Address
First Line	:	5400 TRANSPORTATION BL.
Second Line	:	STE. 12A
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125
Country	:	US
Telephone Number	:	216-663-3287
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 TRANSPORTATION BLVD
Second Line	:	STE. 12A
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-5324
Country	:	US
Telephone Number	:	216-663-3287
Fax Number	:

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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