MEDICARE: MR. MARK JOHN HAWRYLO II 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
1	104100000X	Social Worker	I9073	OH

General Provider Information

NPI Number	:	1033190236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK JOHN HAWRYLO II LISW

Provider Business Mailing Address
First Line	:	7519 MENTOR AVE
Second Line	:	SUITE - A- 110
City	:	MENTOR
State	:	OH
Zip	:	44060-5434
Country	:	US
Telephone Number	:	440-521-4673
Fax Number	:	440-521-4673

Provider Business Practice Location Address
First Line	:	7519 MENTOR AVE
Second Line	:	SUITE - A- 110
City	:	MENTOR
State	:	OH
Zip	:	44060-5434
Country	:	US
Telephone Number	:	440-521-4673
Fax Number	:	440-521-4673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	04/19/2026

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