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General NPI Number Information
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NPI Number | 1134734668
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Entity Type | Individual
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Provider Name | ALEXIS CARDER QMHS BA CMS MSW
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Gender | Female
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 9220 MENTOR AVE
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City | MENTOR
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State | OH
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Zip | 44060-6412
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Country | US
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Telephone | 440-639-3585
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Fax |
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Provider Business Mailing Address
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Address Line | 24801 LAKE SHORE BLVD # B703
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City | EUCLID
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State | OH
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Zip | 44123-1275
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Country | US
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Telephone | 740-457-3714
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2208339
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License Number State | OH
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