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NPI Code Detail

MEDICARE: MIRANDA ELIZABETH LEWIS LSW

MEDICARE: MIRANDA ELIZABETH LEWIS 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
1104100000XSocial WorkerS.1701796OH
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1174271894
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA ELIZABETH LEWIS LSW
Provider Business Mailing Address
First Line : 36500 AURORA RD
Second Line :
City : SOLON
State : OH
Zip : 44139-4648
Country : US
Telephone Number : 440-591-8696
Fax Number :
Provider Business Practice Location Address
First Line : 3922 LOVERS LN
Second Line :
City : RAVENNA
State : OH
Zip : 44266-4200
Country : US
Telephone Number : 800-673-1347
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2022
Last Update Date : 03/16/2026

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