Healthcare Provider Details

I. General information

NPI: 1811495997
Provider Name (Legal Business Name): LAURA BASKIN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 W 25TH ST
CLEVELAND OH
44113-3170
US

IV. Provider business mailing address

1730 W 25TH ST
CLEVELAND OH
44113-3170
US

V. Phone/Fax

Practice location:
  • Phone: 216-363-2122
  • Fax:
Mailing address:
  • Phone: 216-363-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1903830
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: