Healthcare Provider Details

I. General information

NPI: 1891378378
Provider Name (Legal Business Name): ISABEL STOVSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12557 RAVENWOOD DR
CHARDON OH
44024-9009
US

IV. Provider business mailing address

3336 AVALON RD
SHAKER HEIGHTS OH
44120-3416
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-3568
  • Fax:
Mailing address:
  • Phone: 216-385-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1891378378
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: