Healthcare Provider Details

I. General information

NPI: 1316141823
Provider Name (Legal Business Name): BRIANNE ALABURDA LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12557 RAVENWOOD DR
CHARDON OH
44024-9009
US

IV. Provider business mailing address

12557 RAVENWOOD DR
CHARDON OH
44024-9009
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-3568
  • Fax:
Mailing address:
  • Phone: 440-285-3568
  • Fax: 440-285-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0700209
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0900101
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: