Healthcare Provider Details

I. General information

NPI: 1720337082
Provider Name (Legal Business Name): CARRIE ANN JANCAR MSSA, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2012
Last Update Date: 09/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11565 PEARL RD STE 200
STRONGSVILLE OH
44136-3356
US

IV. Provider business mailing address

11565 PEARL RD STE 200
STRONGSVILLE OH
44136-3356
US

V. Phone/Fax

Practice location:
  • Phone: 440-846-0862
  • Fax: 440-846-0890
Mailing address:
  • Phone: 440-846-0862
  • Fax: 440-846-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100160
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: