Healthcare Provider Details

I. General information

NPI: 1558844514
Provider Name (Legal Business Name): RACHAEL ROSE LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL ROSE

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9826 WASHINGTON ST
CHAGRIN FALLS OH
44023-5401
US

IV. Provider business mailing address

9826 WASHINGTON ST
CHAGRIN FALLS OH
44023-5401
US

V. Phone/Fax

Practice location:
  • Phone: 440-708-0188
  • Fax: 440-708-0368
Mailing address:
  • Phone: 440-708-0188
  • Fax: 440-708-0368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2405474
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: