MEDICARE: MS. KELLY HERBIN LSW

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	S08001062	OH

General Provider Information

NPI Number	:	1346669702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY HERBIN LSW

Provider Business Mailing Address
First Line	:	1516 GENESEE RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-2753
Country	:	US
Telephone Number	:	216-339-3227
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 GENESEE RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-2753
Country	:	US
Telephone Number	:	216-339-3227
Fax Number	:

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	04/14/2014

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