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NPI Code Detail

MEDICARE: TAYLOR MATUSIK LCDC III

MEDICARE: TAYLOR MATUSIK LCDC III
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
1171M00000XCase Manager/Care Coordinator
2101YA0400XAddiction (Substance Use Disorder) Counselor162450OH

General Provider Information

NPI Number : 1528559473
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR MATUSIK LCDC III
Provider Business Mailing Address
First Line : 1804 E 55TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44103-3602
Country : US
Telephone Number : 216-762-1237
Fax Number :
Provider Business Practice Location Address
First Line : 1804 E 55TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44103-3602
Country : US
Telephone Number : 216-762-1237
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2018
Last Update Date : 07/05/2023

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