MEDICARE: MARIA DURBIN 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	I-0600023	OH

General Provider Information

NPI Number	:	1720143001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA DURBIN LISW

Provider Business Mailing Address
First Line	:	2173 N RIDGE RD E
Second Line	:	SUITE E
City	:	LORAIN
State	:	OH
Zip	:	44055-3400
Country	:	US
Telephone Number	:	440-260-6108
Fax Number	:	440-282-3400

Provider Business Practice Location Address
First Line	:	2173 N RIDGE RD E
Second Line	:	SUITE E
City	:	LORAIN
State	:	OH
Zip	:	44055-3400
Country	:	US
Telephone Number	:	440-260-6108
Fax Number	:	440-282-3400

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	05/10/2016

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