Healthcare Provider Details

I. General information

NPI: 1861846966
Provider Name (Legal Business Name): JENNIFER SAPORITO LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER DRAGIN

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7185 LIBERTY CENTRE DR SUITE D
LIBERTY TOWNSHIP OH
45069-6586
US

IV. Provider business mailing address

25101 CHAGRIN BLVD SUITE 100
BEACHWOOD OH
44122-5643
US

V. Phone/Fax

Practice location:
  • Phone: 513-504-9310
  • Fax: 513-847-6365
Mailing address:
  • Phone: 216-831-6611
  • Fax: 216-456-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0002569-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: