MEDICARE: MS. MIRANDA FELICE SMITH MSW

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	6616	TN
2	1041C0700X	Clinical Social Worker	S.0025478	OH
3	1041C0700X	Clinical Social Worker	I0900074	OH

General Provider Information

NPI Number	:	1992809313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MIRANDA FELICE SMITH MSW

Provider Business Mailing Address
First Line	:	25975 CAMBRIDGE DR
Second Line	:
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-3142
Country	:	US
Telephone Number	:	440-786-9092
Fax Number	:

Provider Business Practice Location Address
First Line	:	10701 EAST BLVD.
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44146
Country	:	US
Telephone Number	:	216-791-3800
Fax Number	:	216-421-3220

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

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	12/15/2020

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