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NPI Code Detail

MEDICARE: MARVELLA DONALD LSW

MEDICARE: MARVELLA DONALD LSW
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2104100000XSocial WorkerS1903313OH

General Provider Information

NPI Number : 1104335447
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARVELLA DONALD LSW
Provider Business Mailing Address
First Line : 620 TURNEY RD
Second Line :
City : BEDFORD
State : OH
Zip : 44146-3375
Country : US
Telephone Number : 216-712-0240
Fax Number :
Provider Business Practice Location Address
First Line : 2301 SCRANTON RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-4311
Country : US
Telephone Number : 216-273-6998
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2017
Last Update Date : 02/13/2024

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