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General NPI Number Information
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NPI Number | 1528550852
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Entity Type | Individual
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Provider Name | LISBETH MARY WILEY LSW
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Gender | Female
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 26777 LORAIN RD STE 416
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3224
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Country | US
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Telephone | 440-915-3093
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Fax |
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Provider Business Mailing Address
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Address Line | 2689 JOSEPH ST
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City | AVON
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State | OH
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Zip | 44011-1909
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Country | US
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Telephone | 440-937-0205
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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 | S.0010695
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License Number State | OH
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