Healthcare Provider Details

I. General information

NPI: 1083963441
Provider Name (Legal Business Name): RENEE LEBER LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE CHAFFEE

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CENTER ST STE A
BERLIN HEIGHTS OH
44814-9603
US

IV. Provider business mailing address

PO BOX 145
BERLIN HEIGHTS OH
44814-0145
US

V. Phone/Fax

Practice location:
  • Phone: 419-515-6865
  • Fax: 419-938-1077
Mailing address:
  • Phone: 419-515-6865
  • Fax: 419-938-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1200037-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: