Healthcare Provider Details

I. General information

NPI: 1821605635
Provider Name (Legal Business Name): STEPHANIE KEMP LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18780 BAGLEY RD
CLEVELAND OH
44130-3303
US

IV. Provider business mailing address

25700 SCIENCE PARK DR STE 200
BEACHWOOD OH
44122-7328
US

V. Phone/Fax

Practice location:
  • Phone: 404-816-8200
  • Fax:
Mailing address:
  • Phone: 216-831-1040
  • Fax: 216-831-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2506439
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: