Healthcare Provider Details

I. General information

NPI: 1619665411
Provider Name (Legal Business Name): ELIZABETH VIIBERG SA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6133 ROCKSIDE RD STE 403
INDEPENDENCE OH
44131-2244
US

IV. Provider business mailing address

PO BOX 360823
STRONGSVILLE OH
44136-0014
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-5571
  • Fax: 330-331-5805
Mailing address:
  • Phone: 216-455-5571
  • Fax: 330-331-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2202654-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: