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NPI Code Detail

MEDICARE: WANDA LENORE SMART LISW-S

MEDICARE: WANDA LENORE SMART 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
11041C0700XClinical Social WorkerI.0008598OH

General Provider Information

NPI Number : 1669053658
Entity Type Code : Individual
Provider Name (Legal Business Name) : WANDA LENORE SMART LISW-S
Provider Business Mailing Address
First Line : 3784 E 153RD ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44128-1110
Country : US
Telephone Number : 216-225-2636
Fax Number :
Provider Business Practice Location Address
First Line : 2554 W 25TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-4700
Country : US
Telephone Number : 216-781-2250
Fax Number : 216-781-2252
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2021
Last Update Date : 04/20/2021

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Directions to “ WANDA LENORE SMART LISW-S” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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