Healthcare Provider Details

I. General information

NPI: 1649848243
Provider Name (Legal Business Name): STEFAN K BUDZ LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 EUCLID AVE STE 200
CLEVELAND OH
44115-2418
US

IV. Provider business mailing address

1388 LAKELAND AVE APT 4
LAKEWOOD OH
44107-2450
US

V. Phone/Fax

Practice location:
  • Phone: 216-396-3466
  • Fax:
Mailing address:
  • Phone: 216-396-3466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2310027
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: