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NPI Code Detail

MEDICARE: CANDACE B RISEN LISW

MEDICARE: CANDACE B RISEN 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-0001031OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000260213OTHEROHANTHEM BC/BS
2038397000OTHEROHMAGELLAN

General Provider Information

NPI Number : 1194821819
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE B RISEN LISW
Provider Business Mailing Address
First Line : 23425 COMMERCE PARK
Second Line : STE 104
City : BEACHWOOD
State : OH
Zip : 44122-5848
Country : US
Telephone Number : 216-831-2900
Fax Number : 216-831-4306
Provider Business Practice Location Address
First Line : 23230 CHAGRIN BLVD
Second Line : SUITE 350
City : BEACHWOOD
State : OH
Zip : 44122-5446
Country : US
Telephone Number : 216-831-2900
Fax Number : 216-831-4306
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 01/30/2017

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1366549487 — LEVINE, RISEN & ASSOCIATES, INC.
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1528166139 — SAMIA HASAN MD
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1659479038 — STEPHEN B LEVINE MD
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1578654596 — MARVIN WASMAN PHD
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Directions to “ CANDACE B RISEN LISW” Practice Location

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