1558366831 NPI number — MS. JODY NONE BERNON-WAINER LISW

Table of content: MS. JODY NONE BERNON-WAINER LISW (NPI 1558366831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558366831 NPI number — MS. JODY NONE BERNON-WAINER LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNON-WAINER
Provider First Name:
JODY
Provider Middle Name:
NONE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558366831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 FARMCOTE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORELAND HILLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44022-6840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-247-8698
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 GREEN RD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-5719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-464-6705
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I-0000385 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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