MEDICARE: AMY ELIZABETH SALIM LISW-S, LICDC-CS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.081117	OH
2	1041C0700X	Clinical Social Worker	I.070090-SUPV	OH

General Provider Information

NPI Number	:	1750411302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ELIZABETH SALIM LISW-S, LICDC-CS

Provider Business Mailing Address
First Line	:	3029 RIVIERA LN
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-6842
Country	:	US
Telephone Number	:	412-310-8526
Fax Number	:

Provider Business Practice Location Address
First Line	:	4282 CLAGUE RD
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-2313
Country	:	US
Telephone Number	:	440-941-9563
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	09/29/2023

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