Active NPI
Tanya Dissell, LSW
- Social Worker
- Shaker Heights, OH
National Provider Identifier
1750873253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.2410357
- Practice address
- 22001 Fairmount Blvd
Shaker Heights, OH 44118-4819 - Phone
- (216) 932-2800
- NPI assigned
- May 31, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | |||
| Social Worker | 104100000X | S.2410357 | OH | Primary |
Addresses
Primary practice location
22001 Fairmount Blvd
Shaker Heights, OH 44118-4819
Mailing address
7232 Justin Way
Mentor, OH 44060-4881
Phone (440) 578-8200
Other practice location 1
1744 Payne Ave
Cleveland, OH 44114-2910
Phone (216) 623-6555
Other practice location 2
3500 Carnegie Ave
Cleveland, OH 44115-2641
Phone (440) 260-8300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0292662 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.2410357 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707350400000",
"number": "1750873253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7232 JUSTIN WAY",
"city": "MENTOR",
"state": "OH",
"postal_code": "440604881",
"telephone_number": "440-578-8200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22001 FAIRMOUNT BLVD",
"city": "SHAKER HEIGHTS",
"state": "OH",
"postal_code": "441184819",
"telephone_number": "216-932-2800"
}
],
"practiceLocations": [
{
"address_1": "1744 Payne Ave",
"address_purpose": "LOCATION",
"city": "Cleveland",
"state": "OH",
"postal_code": "441142910",
"country_code": "US",
"telephone_number": "216-623-6555",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3500 Carnegie Ave",
"address_purpose": "LOCATION",
"city": "Cleveland",
"state": "OH",
"postal_code": "441152641",
"country_code": "US",
"telephone_number": "440-260-8300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DISSELL",
"first_name": "TANYA",
"credential": "LSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-05-31",
"last_updated": "2024-02-08",
"certification_date": "2024-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.2410357",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0292662",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shaker Heights, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.