MEDICARE: MS. SANTACIA EDMOND LSW

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

General Provider Information

NPI Number	:	1801393699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANTACIA EDMOND LSW

Provider Business Mailing Address
First Line	:	18661 RAYMOND ST
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-1643
Country	:	US
Telephone Number	:	440-661-5241
Fax Number	:

Provider Business Practice Location Address
First Line	:	27600 CHAGRIN BLVD STE 300
Second Line	:
City	:	WOODMERE
State	:	OH
Zip	:	44122-4421
Country	:	US
Telephone Number	:	216-417-8813
Fax Number	:	216-916-4783

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

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	11/26/2024

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