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NPI Code Detail

MEDICARE: MISS LORETTA IRMENGARDIS GERHARDT LSW, CDCA

MEDICARE: MISS LORETTA IRMENGARDIS GERHARDT LSW, CDCA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor080213OH
21041C0700XClinical Social WorkerS.0017802OH

General Provider Information

NPI Number : 1487162681
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS LORETTA IRMENGARDIS GERHARDT LSW, CDCA
Provider Business Mailing Address
First Line : 3135 LORAIN AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-3407
Country : US
Telephone Number : 216-631-4741
Fax Number : 216-631-2379
Provider Business Practice Location Address
First Line : 3135 LORAIN AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-3407
Country : US
Telephone Number : 216-631-4741
Fax Number : 216-631-2379
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2018
Last Update Date : 01/22/2018

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