Healthcare Provider Details

I. General information

NPI: 1932749330
Provider Name (Legal Business Name): SAMUEL GEOFFREY MOORMAN LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3518 W 25TH ST
CLEVELAND OH
44109-1951
US

IV. Provider business mailing address

3518 W 25TH ST
CLEVELAND OH
44109-1951
US

V. Phone/Fax

Practice location:
  • Phone: 216-741-2241
  • Fax:
Mailing address:
  • Phone: 216-741-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: