1780801951 NPI number — MS. SUSAN M DOERFER LISW OH

Table of content: MS. SUSAN M DOERFER LISW OH (NPI 1780801951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780801951 NPI number — MS. SUSAN M DOERFER LISW OH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOERFER
Provider First Name:
SUSAN
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LISW OH
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:
1780801951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6600 DETROIT AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-651-5428
Provider Business Mailing Address Fax Number:
216-651-6439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6600 DETROIT AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-651-5428
Provider Business Practice Location Address Fax Number:
216-651-6439
Provider Enumeration Date:
04/19/2007

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: 101YM0800X , with the licence number:  I0009423 , 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)

  • Identifier: 2286795 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000334429 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7919800 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1000693 . This is a "QUAL CHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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