MEDICARE: RENEE TAYLOR 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
1	1041C0700X	Clinical Social Worker
2	104100000X	Social Worker
3	1041C0700X	Clinical Social Worker	I.2405971	OH

General Provider Information

NPI Number	:	1255198800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE TAYLOR LISW

Provider Business Mailing Address
First Line	:	4021 BUSHNELL RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3305
Country	:	US
Telephone Number	:	216-773-0538
Fax Number	:

Provider Business Practice Location Address
First Line	:	4021 BUSHNELL RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3305
Country	:	US
Telephone Number	:	216-773-0538
Fax Number	:

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

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	01/27/2025

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Directions to “ RENEE TAYLOR LISW” Practice Location

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