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NPI Code Detail

MEDICARE: TONYA J PREWITT LISW

MEDICARE: TONYA J PREWITT 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 WorkerI.1100129OH

General Provider Information

NPI Number : 1588946149
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA J PREWITT LISW
Provider Business Mailing Address
First Line : 24865 DETROIT RD
Second Line :
City : WESTLAKE
State : OH
Zip : 44145-2512
Country : US
Telephone Number : 248-703-4621
Fax Number :
Provider Business Practice Location Address
First Line : 24865 DETROIT RD
Second Line :
City : WESTLAKE
State : OH
Zip : 44145-2512
Country : US
Telephone Number : 248-703-4621
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2011
Last Update Date : 09/09/2011

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Directions to “ TONYA J PREWITT LISW” Practice Location

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