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NPI Code Detail

MEDICARE: MRS. NAOMI HARRISON OPDYCKE LISW

MEDICARE: MRS. NAOMI HARRISON OPDYCKE 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
1101YM0800XMental Health CounselorI-0004331OH

General Provider Information

NPI Number : 1700905031
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NAOMI HARRISON OPDYCKE LISW
Provider Business Mailing Address
First Line : 21716 KENWOOD AVE
Second Line :
City : ROCKY RIVER
State : OH
Zip : 44116-1236
Country : US
Telephone Number : 440-333-6949
Fax Number :
Provider Business Practice Location Address
First Line : 17407 LORAIN AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-4022
Country : US
Telephone Number : 216-671-9272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 07/08/2007

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