Healthcare Provider Details

I. General information

NPI: 1730444027
Provider Name (Legal Business Name): JASON KUHARIK LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30800 CHAGRIN BLVD
CLEVELAND OH
44124-5925
US

IV. Provider business mailing address

30800 CHAGRIN BLVD
CLEVELAND OH
44124-5925
US

V. Phone/Fax

Practice location:
  • Phone: 216-591-0324
  • Fax: 216-591-1243
Mailing address:
  • Phone: 216-591-0324
  • Fax: 216-591-1243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0600833
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: