MEDICARE: MS. PATRICIA JUSTICE LISW-S

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. 0011556	OH

General Provider Information

NPI Number	:	1326235870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA JUSTICE LISW-S

Provider Business Mailing Address
First Line	:	7544 WHITEMARSH WAY
Second Line	:
City	:	HUDSON
State	:	OH
Zip	:	44236-4680
Country	:	US
Telephone Number	:	216-316-4436
Fax Number	:	216-587-8646

Provider Business Practice Location Address
First Line	:	12300 MCCRACKEN RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-2914
Country	:	US
Telephone Number	:	216-316-4436
Fax Number	:

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

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	08/30/2022

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