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General NPI Number Information
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NPI Number | 1144776527
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Entity Type | Individual
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Provider Name | RICCARDO WILLIS
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Gender | Male
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Dates
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Enumeration Date | 08/26/2016
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 10701 EAST BLVD
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City | CLEVELAND
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State | OH
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Zip | 44106-1702
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Country | US
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Telephone | 216-791-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 371 E 215TH ST
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City | EUCLID
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State | OH
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Zip | 44123-1959
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Country | US
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Telephone | 216-246-7332
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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 | CP0094433
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License Number State | WV
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