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NPI Code Detail

MEDICARE: ROCHENA CROSBY LISW-S

MEDICARE:   ROCHENA  CROSBY  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
1101YA0400XAddiction (Substance Use Disorder) Counselor131183OH
21041C0700XClinical Social WorkerI.1700038-SUPVOH

General Provider Information

NPI Number : 1154879484
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROCHENA CROSBY LISW-S
Provider Business Mailing Address
First Line : 2490 LEE BLVD STE 106
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44118-1271
Country : US
Telephone Number : 216-376-9647
Fax Number :
Provider Business Practice Location Address
First Line : 2490 LEE BLVD STE 106
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44118-1271
Country : US
Telephone Number : 216-376-9647
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2016
Last Update Date : 08/12/2024

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Directions to “ ROCHENA CROSBY LISW-S” Practice Location

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