Healthcare Provider Details

I. General information

NPI: 1427472687
Provider Name (Legal Business Name): JOSEPH ANTHONY CIRINO LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2014
Last Update Date: 10/16/2021
Certification Date: 10/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 MAYFIELD RD STE 210
CHESTERLAND OH
44026-2583
US

IV. Provider business mailing address

664 ECHO DR
GATES MILLS OH
44040-9606
US

V. Phone/Fax

Practice location:
  • Phone: 440-423-5870
  • Fax:
Mailing address:
  • Phone: 440-227-4158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2102649
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberS.0031909
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: