MEDICARE: MS. ELIZABETH VINCENT LSW, MSW

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
1	104100000X	Social Worker	S1501225	OH

General Provider Information

NPI Number	:	1538601307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH VINCENT LSW, MSW

Provider Business Mailing Address
First Line	:	3645 WARRENSVILLE CENTER RD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44122-5247
Country	:	US
Telephone Number	:	216-310-9371
Fax Number	:

Provider Business Practice Location Address
First Line	:	3645 WARRENSVILLE CENTER RD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44122-5247
Country	:	US
Telephone Number	:	216-310-9371
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2016
Last Update Date	:	11/10/2016

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