MEDICARE: MRS. JUDITH H VERBA 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	104100000X	Social Worker

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9235411	OTHER		MEDICARE B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700065539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDITH H VERBA LISW

Provider Business Mailing Address
First Line	:	11900 FAIRHILL RD
Second Line	:	SUITE 300
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1053
Country	:	US
Telephone Number	:	216-373-1788
Fax Number	:	216-373-8014

Provider Business Practice Location Address
First Line	:	11900 FAIRHILL RD
Second Line	:	SUITE 300
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1053
Country	:	US
Telephone Number	:	216-373-1788
Fax Number	:	216-373-8014

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

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	10/29/2007

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Directions to “ MRS. JUDITH H VERBA LISW” Practice Location

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