Healthcare Provider Details

I. General information

NPI: 1821017369
Provider Name (Legal Business Name): MARJORIE SULIN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35888 CENTER RIDGE RD SUITE5
NORTH RIDGEVILLE OH
44039-3086
US

IV. Provider business mailing address

35888 CENTER RIDGE RD SUITE5
NORTH RIDGEVILLE OH
44039-3086
US

V. Phone/Fax

Practice location:
  • Phone: 440-327-1800
  • Fax: 440-327-1533
Mailing address:
  • Phone: 440-327-1800
  • Fax: 440-327-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0008171
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: