MEDICARE: FAITH GOINS SWT

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	S1901010-TRNE	OH

General Provider Information

NPI Number	:	1962053827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH GOINS SWT

Provider Business Mailing Address
First Line	:	310 W LAKESIDE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-1044
Country	:	US
Telephone Number	:	216-443-8250
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 W LAKESIDE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-1044
Country	:	US
Telephone Number	:	216-443-8250
Fax Number	:

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

Provider Enumeration Date	:	09/23/2019
Last Update Date	:	09/23/2019

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Directions to “ FAITH GOINS SWT” Practice Location

Language	Start Address	Practice Location

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