MEDICARE: LANA AMAWI MSSA, 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
1	1041C0700X	Clinical Social Worker	6801083102	MI
2	1041C0700X	Clinical Social Worker	18257	MN
3	1041C0700X	Clinical Social Worker	I0700452	OH

General Provider Information

NPI Number	:	1730162165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANA AMAWI MSSA, LISW-S

Provider Business Mailing Address
First Line	:	37303 HARVEST AVE
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-2803
Country	:	US
Telephone Number	:	440-799-2595
Fax Number	:

Provider Business Practice Location Address
First Line	:	37303 HARVEST AVE
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-2803
Country	:	US
Telephone Number	:	440-799-2595
Fax Number	:

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	12/10/2012

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