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NPI Code Detail

MEDICARE: ELLEN KAYE LISW

MEDICARE: ELLEN KAYE 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 WorkerSW 8198FL
21041C0700XClinical Social WorkerI.1000313-SUPVOH

General Provider Information

NPI Number : 1205884731
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN KAYE LISW
Provider Business Mailing Address
First Line : 20600 CHAGRIN BLVD STE 620
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44122-5340
Country : US
Telephone Number : 216-548-7850
Fax Number : 305-891-9647
Provider Business Practice Location Address
First Line : 20600 CHAGRIN BLVD STE 620
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44122-5340
Country : US
Telephone Number : 216-548-7850
Fax Number : 216-751-5894
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 01/16/2018

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Directions to “ ELLEN KAYE LISW” Practice Location

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