Healthcare Provider Details

I. General information

NPI: 1144781725
Provider Name (Legal Business Name): CHARLENE SANDFORD-WILLIAMS BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHARLENE WILLIAMS

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 CHAGRIN BLVD STE 320
SHAKER HEIGHTS OH
44122-5334
US

IV. Provider business mailing address

20600 CHAGRIN BLVD STE 320
SHAKER HEIGHTS OH
44122-5334
US

V. Phone/Fax

Practice location:
  • Phone: 216-295-7239
  • Fax: 216-295-7240
Mailing address:
  • Phone: 216-295-7239
  • Fax: 216-295-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberAPP-00019121
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: