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NPI Code Detail

MEDICARE: CHRISTINE HUMPHREY LISW

MEDICARE:   CHRISTINE  HUMPHREY  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 Worker

General Provider Information

NPI Number : 1508068883
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE HUMPHREY LISW
Provider Business Mailing Address
First Line : 38317 RIDGE RD
Second Line :
City : WILLOUGHBY
State : OH
Zip : 44094-5864
Country : US
Telephone Number : 440-951-8382
Fax Number :
Provider Business Practice Location Address
First Line : 12504 CEDAR RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44106-3217
Country : US
Telephone Number : 216-371-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2007
Last Update Date : 07/08/2007

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Directions to “ CHRISTINE HUMPHREY LISW” Practice Location

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