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NPI Code Detail

MEDICARE: ANNA LISA CLARK LISW, LICDC

MEDICARE: ANNA LISA CLARK LISW, LICDC
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-0007941OH
2101YA0400XAddiction (Substance Use Disorder) Counselor862262OH

General Provider Information

NPI Number : 1457376485
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA LISA CLARK LISW, LICDC
Provider Business Mailing Address
First Line : 35888 CENTER RIDGE RD
Second Line : SUITE 5
City : NORTH RIDGEVILLE
State : OH
Zip : 44039-3086
Country : US
Telephone Number : 440-327-1800
Fax Number : 440-327-1533
Provider Business Practice Location Address
First Line : 35888 CENTER RIDGE RD
Second Line : SUITE 5
City : NORTH RIDGEVILLE
State : OH
Zip : 44039-3086
Country : US
Telephone Number : 440-327-1800
Fax Number : 440-327-1533
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 09/11/2025

Similar Medicare Providers

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1780612432 — MR. TIMOTHY P. GOLBA LISW
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1326063363 — MR. JOHN M. ELLIS LISW, LICDC
Practice Location Address:
35888 CENTER RIDGE RD , SUITE 5
NORTH RIDGEVILLE, OH
44039-3086
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1821017369 — MRS. MARJORIE SULIN LISW
Practice Location Address:
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1124049697 — JANET MARIE JONES PCC
Practice Location Address:
35888 CENTER RIDGE RD , SUITE 5
NORTH RIDGEVILLE, OH
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1679596290 — DR. TIMOTHY PETREY LISW
Practice Location Address:
35888 CENTER RIDGE RD , SUITE 5
NORTH RIDGEVILLE, OH
44039-3086
Practice Phone: 440-327-1800
Practice Fax: 440-327-1533

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