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NPI Code Detail

MEDICARE: MRS. KIMBERLY ANNE COHEN LISW

MEDICARE: MRS. KIMBERLY ANNE COHEN 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
11041C0700XClinical Social Worker0007626OH

General Provider Information

NPI Number : 1477600492
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY ANNE COHEN LISW
Provider Business Mailing Address
First Line : PO BOX 391057
Second Line :
City : SOLON
State : OH
Zip : 44139-8057
Country : US
Telephone Number : 440-668-8564
Fax Number : 877-844-4869
Provider Business Practice Location Address
First Line : 6575 ASHTON LN
Second Line :
City : SOLON
State : OH
Zip : 44139-3213
Country : US
Telephone Number : 440-668-8564
Fax Number : 877-844-4869
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2007
Last Update Date : 08/16/2010

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