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General NPI Number Information
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NPI Number | 1366888612
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Entity Type | Individual
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Provider Name | JAY BRIAN HARBECK CMSW
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Gender | Male
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 2800 EUCLID AVE STE 335
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City | CLEVELAND
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State | OH
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Zip | 44115-2496
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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 | 2800 EUCLID AVE STE 335
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City | CLEVELAND
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State | OH
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Zip | 44115-2496
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Country | US
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Telephone |
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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 | Q1-0001219
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 962
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I1502417-SUPV
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License Number State | OH
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