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NPI Code Detail

MEDICARE: JEFFREY DISTIN PCC-S

MEDICARE: JEFFREY DISTIN PCC-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
1101YP2500XProfessional CounselorE.0600654OH

General Provider Information

NPI Number : 1689023335
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY DISTIN PCC-S
Provider Business Mailing Address
First Line : 8411 BROADWAY AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44105-3932
Country : US
Telephone Number : 216-206-5201
Fax Number : 216-441-3637
Provider Business Practice Location Address
First Line : 8411 BROADWAY AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44105-3932
Country : US
Telephone Number : 216-206-5201
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2016
Last Update Date : 06/03/2016

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Directions to “ JEFFREY DISTIN PCC-S” Practice Location

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