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NPI Code Detail

MEDICARE: JEFFREY JOSEPH URGO LISW

MEDICARE: JEFFREY JOSEPH URGO LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI0005688OH

General Provider Information

NPI Number : 1013013879
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY JOSEPH URGO LISW
Provider Business Mailing Address
First Line : 30 E BROAD ST
Second Line : 11TH FL
City : COLUMBUS
State : OH
Zip : 43215-3414
Country : US
Telephone Number : 614-466-9930
Fax Number : 614-644-9116
Provider Business Practice Location Address
First Line : 1756 SAGAMORE RD
Second Line :
City : NORTHFIELD
State : OH
Zip : 44067-1086
Country : US
Telephone Number : 330-467-7131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 07/08/2007

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