Healthcare Provider Details

I. General information

NPI: 1841493822
Provider Name (Legal Business Name): SHARON NACSON L.I.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19910 MALVERN RD # 207
SHAKER HEIGHTS OH
44122-2823
US

IV. Provider business mailing address

3347 BRADFORD RD
CLEVELAND HEIGHTS OH
44118-4229
US

V. Phone/Fax

Practice location:
  • Phone: 216-548-0578
  • Fax:
Mailing address:
  • Phone: 216-321-4867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS29990
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS29990
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: