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NPI Code Detail

MEDICARE: MR. ROBERT E. PERSSE LISW

MEDICARE: MR. ROBERT E. PERSSE 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-0002031OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225140890
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT E. PERSSE LISW
Provider Business Mailing Address
First Line : 3290 HYDE PARK AVE
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44118-2132
Country : US
Telephone Number : 216-932-5745
Fax Number :
Provider Business Practice Location Address
First Line : 29133 HEALTH CAMPUS DR
Second Line :
City : WESTLAKE
State : OH
Zip : 44145-5256
Country : US
Telephone Number : 440-835-6212
Fax Number : 440-835-6231
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/09/2007

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