MEDICARE: MRS. MARIANNE SACHS

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	I L302660	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	I L302660	OTHER	OH	PROFESSIONAL STATE LICENSE

General Provider Information

NPI Number	:	1740669464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIANNE SACHS

Provider Business Mailing Address
First Line	:	3236 E FAIRFAX RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-4206
Country	:	US
Telephone Number	:	216-702-3861
Fax Number	:

Provider Business Practice Location Address
First Line	:	3236 E FAIRFAX RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-4206
Country	:	US
Telephone Number	:	216-702-3861
Fax Number	:

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

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	05/27/2015

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