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NPI Code Detail

MEDICARE: DEVON A FEGEN-HERDMAN LISW

MEDICARE: DEVON A FEGEN-HERDMAN 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
1104100000XSocial WorkerI.0700454-SUPVOH

General Provider Information

NPI Number : 1063922615
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEVON A FEGEN-HERDMAN LISW
Provider Business Mailing Address
First Line : 3100 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2508
Country : US
Telephone Number : 216-361-4400
Fax Number : 216-361-2340
Provider Business Practice Location Address
First Line : 14201 SOUTHINGTON RD
Second Line :
City : SHAKER HTS
State : OH
Zip : 44120-2703
Country : US
Telephone Number : 216-751-8453
Fax Number : 216-751-3780
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2017
Last Update Date : 10/10/2017

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Directions to “ DEVON A FEGEN-HERDMAN LISW” Practice Location

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