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General NPI Number Information
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NPI Number | 1144528332
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Entity Type | Individual
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Provider Name | DAVID J. MENKE LISW, SAP
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Gender | Male
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Dates
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Enumeration Date | 03/11/2011
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Last Update Date | 03/10/2014
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Provider Practice Location Address
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Address Line | 2592 W 14TH ST
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City | CLEVELAND
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State | OH
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Zip | 44113-4409
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Country | US
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Telephone | 216-502-2209
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Fax |
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Provider Business Mailing Address
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Address Line | 2592 W 14TH ST
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City | CLEVELAND
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State | OH
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Zip | 44113-4409
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Country | US
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Telephone | 216-502-2209
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1200439
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.0700443
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License Number State | OH
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