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NPI Code Detail

MEDICARE: MYA CLEMONS LSW

MEDICARE: MYA CLEMONS 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
1104100000XSocial WorkerS2106202OH
2171M00000XCase Manager/Care CoordinatorOH
3172V00000XCommunity Health WorkerOH
4385H00000XRespite Care

General Provider Information

NPI Number : 1518570464
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYA CLEMONS LSW
Provider Business Mailing Address
First Line : 1100 GRAHAM ROAD CIR
Second Line :
City : STOW
State : OH
Zip : 44224-2901
Country : US
Telephone Number : 330-603-3980
Fax Number :
Provider Business Practice Location Address
First Line : 1100 GRAHAM ROAD CIR
Second Line :
City : STOW
State : OH
Zip : 44224-2901
Country : US
Telephone Number : 330-928-0044
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2020
Last Update Date : 02/09/2026

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