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General NPI Number Information
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NPI Number | 1568007011
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Entity Type | Individual
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Provider Name | ANNETTE HUMBERSON LISW-S
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Gender | Female
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 11/07/2019
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE # A100
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-702-3868
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Fax |
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Provider Business Mailing Address
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Address Line | 9889 CLARIUS CIR
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City | TWINSBURG
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State | OH
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Zip | 44087-2939
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Country | US
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Telephone | 216-702-3868
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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.0010183-SUPV
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License Number State | OH
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