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NPI Code Detail

MEDICARE: MICKIE CHANEY

MEDICARE: MICKIE CHANEY
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
21041C0700XClinical Social WorkerI.1801289OH

General Provider Information

NPI Number : 1922508159
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICKIE CHANEY
Provider Business Mailing Address
First Line : 13701 5TH AVE
Second Line :
City : EAST CLEVELAND
State : OH
Zip : 44112-3109
Country : US
Telephone Number : 216-224-1261
Fax Number :
Provider Business Practice Location Address
First Line : 5 SEVERANCE CIR STE 201
Second Line :
City : CLEVELAND HTS
State : OH
Zip : 44118-1567
Country : US
Telephone Number : 216-659-5406
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2018
Last Update Date : 01/24/2023

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Directions to “ MICKIE CHANEY ” Practice Location

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