Theodicies Support LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

THEODICIES SUPPORT LLC

Practice address

3690 Orange PL Ste 120
Beachwood, OH 44122-4438

Phone

(440) 703-0486

Fax

(216) 472-8748

NPI assigned

Nov 15, 2022

Last updated

Nov 15, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shawna Jackson Young, LISW-S, LICDCNPI 1710336896

Title

Clinical Director

Phone

(440) 703-0486

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shawna Jackson Young, LCDC III, LISW

  • Clinical Social Worker
  • Beachwood, OH
  • NPI 1710336896
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668470400000",
    "number": "1083323430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3690 ORANGE PL STE 120",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441224438",
            "telephone_number": "440-703-0486",
            "fax_number": "216-472-8748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3690 ORANGE PL STE 120",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441224438",
            "telephone_number": "440-703-0486",
            "fax_number": "216-472-8748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODICIES SUPPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-15",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A",
        "authorized_official_last_name": "JACKSON YOUNG",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "440-703-0486",
        "authorized_official_credential": "LISW-S, LICDC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Beachwood, OH
• Providers in Beachwood, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.