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NPI Code Detail

MEDICARE: CARLY QUENNEVILLE LSW

MEDICARE: CARLY QUENNEVILLE 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 WorkerS.2613460

General Provider Information

NPI Number : 1528923273
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLY QUENNEVILLE LSW
Provider Business Mailing Address
First Line : 10427 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-1645
Country : US
Telephone Number : 216-521-6511
Fax Number : 216-521-6006
Provider Business Practice Location Address
First Line : 10427 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-1645
Country : US
Telephone Number : 216-521-6511
Fax Number : 216-521-6006
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2025
Last Update Date : 02/13/2026

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Directions to “ CARLY QUENNEVILLE LSW” Practice Location

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