Healthcare Provider Details

I. General information

NPI: 1154663896
Provider Name (Legal Business Name): COLLEEN F MARTIN-TELFER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 MIDWAY BLVD SUITE 204
ELYRIA OH
44035-9006
US

IV. Provider business mailing address

3737 LANDER RD
PEPPER PIKE OH
44124-5712
US

V. Phone/Fax

Practice location:
  • Phone: 440-324-4980
  • Fax: 216-378-3906
Mailing address:
  • Phone: 216-831-2255
  • Fax: 216-378-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0600460
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: