MEDICARE: MR. TODD J ESTERBURG 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.1101255	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912229311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD J ESTERBURG LISW

Provider Business Mailing Address
First Line	:	20033 DETROIT RD STE G
Second Line	:	NORTH RIDGE ANNEX
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-2400
Country	:	US
Telephone Number	:	216-224-9230
Fax Number	:

Provider Business Practice Location Address
First Line	:	20033 DETROIT RD STE G
Second Line	:	NORTH RIDGE ANNEX
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-2400
Country	:	US
Telephone Number	:	216-224-9230
Fax Number	:

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

Provider Enumeration Date	:	02/26/2010
Last Update Date	:	04/05/2024

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