Active NPI
Nancy Distefano, LISW-S
- Clinical Social Worker
- Concord TWP, OH
National Provider Identifier
1699124198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1101608
- Practice address
- 7230 Schooners CV
Concord TWP, OH 44077-9011 - Phone
- (440) 867-3564
- NPI assigned
- Jun 7, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1101608 | OH | Primary |
Addresses
Primary practice location
7230 Schooners CV
Concord TWP, OH 44077-9011
Mailing address
7230 Schooners CV
Concord TWP, OH 44077-9011
Phone (440) 867-3564
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170609001004 | OH | Practitioner - Clinical Social Worker | 5799053013 | Reassigns benefits to 2 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1101608 | OH | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornerstone Behavioral Health LLC | Current | Accepting new patients | |
| Psycho Social Therapies,LTD | Clinical | Current | Accepting new patients |
| Washington Wellness Institute, LLC | Current | Accepting new patients | |
| Psycho Social Therapies,LTD | Current | Accepting new patients | |
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
| Cook Counseling and Consulting Inc. | Clinical | Past | Accepting new patients |
Locations
23715 Mercantile Rd
Ste A203
Beachwood, OH 44122
Phone (216) 292-2880
23366 Commerce Park
Ste 100B
Beachwood, OH 44122
Phone (216) 292-2880
780 E 185th St
Cleveland, OH 44119
Phone (216) 302-4077
14837 Detroit Ave
Lakewood, OH 44107
Phone (216) 952-1490
Interoperability endpoints
- nancydistefano@tdh.allscriptsdirect.net
Organizations & group practices 6
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Beachwood, OH
- NPI 1902462906
-
- Mental Health Counselor
- Cleveland, OH
- NPI 1871155176
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465257600000",
"number": "1699124198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7230 SCHOONERS CV",
"city": "CONCORD TWP",
"state": "OH",
"postal_code": "440779011",
"telephone_number": "440-867-3564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7230 SCHOONERS CV",
"city": "CONCORD TWP",
"state": "OH",
"postal_code": "440779011",
"telephone_number": "440-867-3564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISTEFANO",
"first_name": "NANCY",
"credential": "LISW-S",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-07",
"last_updated": "2016-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "1101608",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord TWP, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.