MEDICARE: ROBERT GARRITY

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.071011	OH
2	1041C0700X	Clinical Social Worker	I.0900179-SUPV	OH

General Provider Information

NPI Number	:	1902469497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT GARRITY

Provider Business Mailing Address
First Line	:	1576 E 32ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-4337
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1576 E 32ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-4337
Country	:	US
Telephone Number	:	440-463-0482
Fax Number	:

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

Provider Enumeration Date	:	04/19/2019
Last Update Date	:	04/19/2019

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