MEDICARE: ALBERT J SANGREGORY 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
1	1041C0700X	Clinical Social Worker	I0005351	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00039605	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000115697	OTHER	OH	ANTHEM BLUE CROSS
2	38740	OTHER		UNITED HEALTHCARE

General Provider Information

NPI Number	:	1710971247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT J SANGREGORY LISW

Provider Business Mailing Address
First Line	:	1110 CASTALIA ST
Second Line	:	STE B
City	:	BELLEVUE
State	:	OH
Zip	:	44811-1181
Country	:	US
Telephone Number	:	419-483-6086
Fax Number	:	419-483-3125

Provider Business Practice Location Address
First Line	:	1110 CASTALIA ST
Second Line	:	STE B
City	:	BELLEVUE
State	:	OH
Zip	:	44811-1181
Country	:	US
Telephone Number	:	419-483-6086
Fax Number	:	419-483-3125

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	08/27/2007

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Directions to “ ALBERT J SANGREGORY LISW” Practice Location

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