Healthcare Provider Details

I. General information

NPI: 1669964425
Provider Name (Legal Business Name): JENNIFER OPRA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 W 3RD ST STE 2
CLEVELAND OH
44113-1514
US

IV. Provider business mailing address

1276 W 3RD ST STE 2
CLEVELAND OH
44113-1514
US

V. Phone/Fax

Practice location:
  • Phone: 216-443-5636
  • Fax:
Mailing address:
  • Phone: 216-443-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS1700521
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: