Healthcare Provider Details

I. General information

NPI: 1083901920
Provider Name (Legal Business Name): JOSEPH B. SESTITO LISW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23210 CHAGRIN BLVD SUITE 211
BEACHWOOD OH
44122-5462
US

IV. Provider business mailing address

23210 CHAGRIN BLVD SUITE 211
BEACHWOOD OH
44122-5462
US

V. Phone/Fax

Practice location:
  • Phone: 440-317-0641
  • Fax:
Mailing address:
  • Phone: 440-317-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0007988-SUPV
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: