MEDICARE: CHRISTINA H REN 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	I0002888	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	137606	OTHER	ND	BLUE CROSS

General Provider Information

NPI Number	:	1982631651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA H REN LISW

Provider Business Mailing Address
First Line	:	3733 PARK EAST DR
Second Line	:	100
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4338
Country	:	US
Telephone Number	:	216-831-6611
Fax Number	:	216-831-2726

Provider Business Practice Location Address
First Line	:	3733 PARK EAST DR
Second Line	:	100
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4338
Country	:	US
Telephone Number	:	216-831-6611
Fax Number	:	216-831-2726

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	07/08/2007

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Directions to “ CHRISTINA H REN LISW” Practice Location

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