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NPI Code Detail

MEDICARE: DENISE ANTOINETT CORNELL

MEDICARE: DENISE ANTOINETT CORNELL
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
1175T00000XPeer Specialist
2101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.190193OH
3171M00000XCase Manager/Care CoordinatorCDCA.190193OH

General Provider Information

NPI Number : 1639712888
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENISE ANTOINETT CORNELL
Provider Business Mailing Address
First Line : 5850 MARRA DR
Second Line :
City : BEDFORD HTS
State : OH
Zip : 44146-3023
Country : US
Telephone Number : 216-376-2452
Fax Number :
Provider Business Practice Location Address
First Line : 5850 MARRA DR
Second Line :
City : BEDFORD HTS
State : OH
Zip : 44146-3023
Country : US
Telephone Number : 216-376-2452
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2019
Last Update Date : 04/15/2026

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Directions to “ DENISE ANTOINETT CORNELL ” Practice Location

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