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NPI Code Detail

MEDICARE: MR. BENJAMIN RUSSELL WENGER MSSA, LISW-S

MEDICARE: MR. BENJAMIN RUSSELL WENGER MSSA, LISW-S
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
11041C0700XClinical Social WorkerI.1302651-SUPVOH

General Provider Information

NPI Number : 1972893964
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BENJAMIN RUSSELL WENGER MSSA, LISW-S
Provider Business Mailing Address
First Line : 5124 CASE AVE
Second Line :
City : LYNDHURST
State : OH
Zip : 44124-1012
Country : US
Telephone Number : 440-313-7090
Fax Number :
Provider Business Practice Location Address
First Line : 27600 CHAGRIN BLVD STE 475
Second Line :
City : WOODMERE
State : OH
Zip : 44122-4421
Country : US
Telephone Number : 440-313-7090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2011
Last Update Date : 09/11/2025

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