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NPI Code Detail

MEDICARE: MS. MADELINE KORTH LISW

MEDICARE: MS. MADELINE KORTH 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.2103199OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598279994
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MADELINE KORTH LISW
Provider Business Mailing Address
First Line : 3500 LORAIN AVE
Second Line : STE 301
City : CLEVELAND
State : OH
Zip : 44113-3726
Country : US
Telephone Number : 216-250-1607
Fax Number : 216-304-6669
Provider Business Practice Location Address
First Line : 12041 RAVENNA RD
Second Line :
City : CHARDON
State : OH
Zip : 44024-7008
Country : US
Telephone Number : 440-286-7154
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2017
Last Update Date : 03/22/2022

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1912368713 — ELIZABETH BRANT LPC-CR, ATR
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1891226411 — GINA LICURSI LSW
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Directions to “ MS. MADELINE KORTH LISW” Practice Location

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