MEDICARE: BRENETTA LOVE 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
1	104100000X	Social Worker	0027754

General Provider Information

NPI Number	:	1134244239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENETTA LOVE LSW

Provider Business Mailing Address
First Line	:	3951 E 67TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-3701
Country	:	US
Telephone Number	:	216-387-3479
Fax Number	:

Provider Business Practice Location Address
First Line	:	3645 WARRENSVILLE CENTER RD
Second Line	:	#246
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-5247
Country	:	US
Telephone Number	:	216-295-7239
Fax Number	:	216-295-7240

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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Directions to “ BRENETTA LOVE LSW” Practice Location

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