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General NPI Number Information
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NPI Number | 1134244239
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Entity Type | Individual
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Provider Name | BRENETTA LOVE LSW
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3645 WARRENSVILLE CENTER RD #246
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-5247
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Country | US
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Telephone | 216-295-7239
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Fax | 216-295-7240
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Provider Business Mailing Address
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Address Line | 3951 E 67TH ST
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City | CLEVELAND
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State | OH
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Zip | 44105-3701
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Country | US
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Telephone | 216-387-3479
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0027754
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License Number State |
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