Healthcare Provider Details

I. General information

NPI: 1861931396
Provider Name (Legal Business Name): PAMELA L HSU LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA L LEE LSW

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 STATION ST STE 102
MENTOR OH
44060-4968
US

IV. Provider business mailing address

1587 E 31ST ST #205
CLEVELAND OH
44114-4366
US

V. Phone/Fax

Practice location:
  • Phone: 216-245-7811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1800797
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1502317
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: