MEDICARE: MS. CONSTANCE DEBORAH WOLFE LISW

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 3414	OH

General Provider Information

NPI Number	:	1841330016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONSTANCE DEBORAH WOLFE LISW

Provider Business Mailing Address
First Line	:	2645 HADDAM RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1531
Country	:	US
Telephone Number	:	216-932-1979
Fax Number	:

Provider Business Practice Location Address
First Line	:	12429 CEDAR RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44106-3199
Country	:	US
Telephone Number	:	216-791-8009
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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