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General NPI Number Information
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NPI Number | 1912226879
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Entity Type | Individual
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Provider Name | CONSTANCE LAWRENCE JAMES LISW, CP
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Gender | Female
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 1228 EUCLID AVE SUITE 200
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City | CLEVELAND
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State | OH
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Zip | 44115-1834
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Country | US
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Telephone | 216-658-1638
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Fax |
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Provider Business Mailing Address
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Address Line | 10515 LONGVIEW TRL
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City | CHAGRIN FALLS
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State | OH
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Zip | 44023-6164
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Country | US
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Telephone | 216-233-1600
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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 1501104
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License Number State | OH
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