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General NPI Number Information
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NPI Number | 1639384845
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Entity Type | Individual
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Provider Name | ADRIENNE ELIZABETH GREEN LISW
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 36000 EUCLID AVE
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City | WILLOUGHBY
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State | OH
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Zip | 44094-4625
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Country | US
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Telephone | 440-602-6421
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Fax | 440-602-6425
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Provider Business Mailing Address
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Address Line | 27090 MALLARD AVE
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City | EUCLID
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State | OH
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Zip | 44132-1517
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Country | US
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Telephone | 216-731-1975
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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 | I0009304
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License Number State | OH
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