Healthcare Provider Details

I. General information

NPI: 1811468622
Provider Name (Legal Business Name): DAVID MONTER LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 BROWN ST
AKRON OH
44301-1515
US

IV. Provider business mailing address

6753 STATE RD
PARMA OH
44134-4517
US

V. Phone/Fax

Practice location:
  • Phone: 330-604-0050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2203702
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number000878
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: