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NPI Code Detail

MEDICARE: ANTON CROSS MSW, LSW LSW,MSW

MEDICARE: ANTON CROSS MSW, LSW LSW,MSW
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) CounselorS.1600080OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1S.1600080OTHEROHLICENSE

General Provider Information

NPI Number : 1184112997
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTON CROSS MSW, LSW LSW,MSW
Provider Business Mailing Address
First Line : 20259 LORAIN RD APT 201
Second Line :
City : FAIRVIEW PARK
State : OH
Zip : 44126-3526
Country : US
Telephone Number : 216-956-6973
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 : 04/26/2018
Last Update Date : 04/26/2018

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