Healthcare Provider Details

I. General information

NPI: 1477600492
Provider Name (Legal Business Name): KIMBERLY ANNE COHEN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6575 ASHTON LN
SOLON OH
44139-3213
US

IV. Provider business mailing address

PO BOX 391057
SOLON OH
44139-8057
US

V. Phone/Fax

Practice location:
  • Phone: 440-668-8564
  • Fax: 877-844-4869
Mailing address:
  • Phone: 440-668-8564
  • Fax: 877-844-4869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0007626
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: