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General NPI Number Information
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NPI Number | 1932576261
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Entity Type | Individual
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Provider Name | STACEY TAYLOR MSSA, LISW
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Gender | Female
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Dates
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Enumeration Date | 08/21/2015
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 3500 CARNEGIE AVE
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City | CLEVELAND
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State | OH
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Zip | 44115-2641
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Country | US
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Telephone | 440-260-8453
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Fax |
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Provider Business Mailing Address
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Address Line | 202 E BAGLEY RD
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City | BEREA
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State | OH
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Zip | 44017-2058
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Country | US
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Telephone |
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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 | S.1501111
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1901631
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License Number State | OH
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