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General NPI Number Information
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NPI Number | 1538265475
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Entity Type | Individual
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Provider Name | TERESE MARIE CYBULSKI LISW
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 24800 HIGHPOINT RD SUITE B
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City | BEACHWOOD
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State | OH
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Zip | 44122-6052
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Country | US
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Telephone | 866-363-6611
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Fax | 216-831-2726
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Provider Business Mailing Address
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Address Line | 145 W 46TH ST
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City | ASHTABULA
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State | OH
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Zip | 44004-6916
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Country | US
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Telephone | 866-363-6611
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Fax | 440-997-4282
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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 | I0002303
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License Number State | OH
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