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NPI Code Detail

MEDICARE: MS. LESLIE D. CLEMENT LISW

MEDICARE: MS. LESLIE D. CLEMENT 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
11041C0700XClinical Social WorkerI-0007551OH

General Provider Information

NPI Number : 1962482455
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LESLIE D. CLEMENT LISW
Provider Business Mailing Address
First Line : 13645 LARCHMERE BLVD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44120-1345
Country : US
Telephone Number : 216-921-1921
Fax Number : 216-932-3138
Provider Business Practice Location Address
First Line : 13645 LARCHMERE BLVD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44120-1345
Country : US
Telephone Number : 216-921-1921
Fax Number : 216-932-3138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2006
Last Update Date : 07/08/2007

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