MEDICARE: NICOLE MARY PODGORSKI 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.162430
2	104100000X	Social Worker	1600701	OH
3	1041C0700X	Clinical Social Worker	I.2506872	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1891213294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARY PODGORSKI LISW

Provider Business Mailing Address
First Line	:	7055 ENGLE RD BLDG 6-601
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-8491
Country	:	US
Telephone Number	:	440-610-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	7055 ENGLE RD BLDG 6-601
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-8491
Country	:	US
Telephone Number	:	440-610-7733
Fax Number	:

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

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	07/22/2025

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