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General NPI Number Information
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NPI Number | 1740721729
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Entity Type | Individual
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Provider Name | JILLIAN NANCY-GRACE BUENO LISW-S
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Gender | Female
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 1730 W 25TH ST
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City | CLEVELAND
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State | OH
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Zip | 44113
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Country | US
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Telephone | 216-696-4030
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Fax |
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Provider Business Mailing Address
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Address Line | 20000 LORAIN RD APT 607
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-3479
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Country | US
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Telephone | 216-402-3060
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Fax | 216-861-7671
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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.1700211-SUPV
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License Number State | OH
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