Healthcare Provider Details

I. General information

NPI: 1629647698
Provider Name (Legal Business Name): JAMIYA MCINTYRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13201 GRANGER RD STE 8
CLEVELAND OH
44125-1979
US

IV. Provider business mailing address

13201 GRANGER RD STE 8
CLEVELAND OH
44125-1979
US

V. Phone/Fax

Practice location:
  • Phone: 216-200-3873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2511795
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: