MEDICARE: KEVIN BLEISTEIN 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	I.1600333-SUPV	OH

General Provider Information

NPI Number	:	1275078438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN BLEISTEIN LISW

Provider Business Mailing Address
First Line	:	3343 BRADFORD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-4229
Country	:	US
Telephone Number	:	570-428-2785
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 MAYFIELD RD STE 204
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1726
Country	:	US
Telephone Number	:	216-245-7470
Fax Number	:

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

Provider Enumeration Date	:	12/27/2016
Last Update Date	:	07/14/2021

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