MEDICARE: LEMOINE PSYCHOTHERAPY INC

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	I1000296	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	I1000296	OTHER	OH	LICENSE

General Provider Information

NPI Number	:	1598253486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEMOINE PSYCHOTHERAPY INC

Provider Business Mailing Address
First Line	:	5968 ASHCROFT DR
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-3137
Country	:	US
Telephone Number	:	216-978-8602
Fax Number	:	931-901-1239

Provider Business Practice Location Address
First Line	:	35010 CHARDON RD
Second Line	:
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44094-9010
Country	:	US
Telephone Number	:	216-978-8602
Fax Number	:	931-901-1239

Authorized Official
Title or Position	:	OWNER
Name	:	KARA ROSE LEMOINE
Credential	:	LISW
Telephone Number	:	216-978-8602

Provider Enumeration Date	:	04/25/2018
Last Update Date	:	04/25/2018

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Directions to “LEMOINE PSYCHOTHERAPY INC ” Practice Location

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