Healthcare Provider Details

I. General information

NPI: 1740468107
Provider Name (Legal Business Name): RICHARD CHARLES ROSICH MSW, LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 SOUTHPOINT DR
CLEVELAND OH
44109-1911
US

IV. Provider business mailing address

30 E BROAD ST 11TH FLOOR
COLUMBUS OH
43215-3414
US

V. Phone/Fax

Practice location:
  • Phone: 216-787-0550
  • Fax: 216-787-0840
Mailing address:
  • Phone: 614-466-6583
  • Fax: 614-644-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0026417
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: