Healthcare Provider Details

I. General information

NPI: 1215966916
Provider Name (Legal Business Name): KATIE SHINBAUM CAHN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21625 CHAGRIN BLVD SUITE 200
BEACHWOOD OH
44122-5363
US

IV. Provider business mailing address

21204 HALWORTH RD
BEACHWOOD OH
44122-3868
US

V. Phone/Fax

Practice location:
  • Phone: 216-751-2864
  • Fax:
Mailing address:
  • Phone: 216-991-0862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI1511
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: