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NPI Code Detail

MEDICARE: CAROL BLOOM LISW

MEDICARE: CAROL BLOOM 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
11041C0700XClinical Social WorkerI.10133OH

General Provider Information

NPI Number : 1154436558
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL BLOOM LISW
Provider Business Mailing Address
First Line : 2525 E 22ND ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-3202
Country : US
Telephone Number : 216-459-9827
Fax Number :
Provider Business Practice Location Address
First Line : 2525 E 22ND ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-3202
Country : US
Telephone Number : 216-459-9827
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 07/08/2007

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Directions to “ CAROL BLOOM LISW” Practice Location

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