MEDICARE: HEARTHSIDE COUNSELING LLC

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

General Provider Information

NPI Number	:	1710771860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTHSIDE COUNSELING LLC

Provider Business Mailing Address
First Line	:	3170 ESSEX RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3538
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3170 ESSEX RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3538
Country	:	US
Telephone Number	:	330-274-4118
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARY LAWRENCE
Credential	:	LISW-S
Telephone Number	:	330-274-4118

Provider Enumeration Date	:	04/05/2025
Last Update Date	:	04/05/2025

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