Healthcare Provider Details

I. General information

NPI: 1003709114
Provider Name (Legal Business Name): BRYANT LOWE LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11565 PEARL RD STE 200
STRONGSVILLE OH
44136-3356
US

IV. Provider business mailing address

7580 HOERTZ RD
PARMA OH
44134-6462
US

V. Phone/Fax

Practice location:
  • Phone: 440-846-0862
  • Fax:
Mailing address:
  • Phone: 216-509-2116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512318
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: