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General NPI Number Information
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NPI Number | 1649579020
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Entity Type | Individual
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Provider Name | PHILIP MICHAEL BIONDO LSW
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Gender | Male
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 22001 FAIRMOUNT BLVD
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44118-4819
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Country | US
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Telephone | 216-320-8338
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Fax | 216-320-8753
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Provider Business Mailing Address
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Address Line | 288 E 151ST ST
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City | CLEVELAND
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State | OH
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Zip | 44110-1215
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Country | US
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Telephone | 216-320-8338
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Fax | 216-320-8753
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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 | S.0018786
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License Number State | OH
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