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NPI Code Detail

MEDICARE: CHERYL KIM LISW-S

MEDICARE: CHERYL KIM LISW-S
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 WorkerI.0029325-SUPVOH

General Provider Information

NPI Number : 1063571594
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL KIM LISW-S
Provider Business Mailing Address
First Line : 434 EASTLAND RD
Second Line :
City : BEREA
State : OH
Zip : 44017-1217
Country : US
Telephone Number : 440-234-2006
Fax Number :
Provider Business Practice Location Address
First Line : 3500 CARNEGIE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2641
Country : US
Telephone Number : 440-260-8900
Fax Number : 440-260-8576
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2006
Last Update Date : 08/12/2019

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