MEDICARE: STEPHANIE KEMP 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.2506439	OH

General Provider Information

NPI Number	:	1821605635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE KEMP LISW

Provider Business Mailing Address
First Line	:	25700 SCIENCE PARK DR STE 200
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-7328
Country	:	US
Telephone Number	:	216-831-1040
Fax Number	:	216-831-2667

Provider Business Practice Location Address
First Line	:	18780 BAGLEY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3303
Country	:	US
Telephone Number	:	404-816-8200
Fax Number	:

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

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	04/17/2025

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