Healthcare Provider Details

I. General information

NPI: 1851743116
Provider Name (Legal Business Name): BRIAN M YANTEK LISW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E 63RD ST
CLEVELAND OH
44103-3833
US

IV. Provider business mailing address

3100 EUCLID AVE
CLEVELAND OH
44115-2508
US

V. Phone/Fax

Practice location:
  • Phone: 216-658-2620
  • Fax: 216-361-2340
Mailing address:
  • Phone: 216-361-4400
  • Fax: 216-361-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberI.0008004-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: