MEDICARE: ANTHONY ALLEN NATHAL 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
1	1041C0700X	Clinical Social Worker	S.1802049	OH

General Provider Information

NPI Number	:	1215576509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY ALLEN NATHAL MSW

Provider Business Mailing Address
First Line	:	2231 N TAYLOR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44112-3044
Country	:	US
Telephone Number	:	216-355-0365
Fax Number	:	216-803-9899

Provider Business Practice Location Address
First Line	:	2231 N TAYLOR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44112-3044
Country	:	US
Telephone Number	:	216-355-0365
Fax Number	:	216-803-9899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2020
Last Update Date	:	01/03/2020

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