Healthcare Provider Details

I. General information

NPI: 1295126472
Provider Name (Legal Business Name): JEFFREY WHITE JR. LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13201 GRANGER RD STE 8
CLEVELAND OH
44125-1979
US

IV. Provider business mailing address

13201 GRANGER RD STE 8
CLEVELAND OH
44125-1979
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-2255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number107241
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2614212
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: