Provider Demographics
NPI:1598775967
Name:MYERS, MARIANN RUITTO (LISW)
Entity Type:Individual
Prefix:MRS
First Name:MARIANN
Middle Name:RUITTO
Last Name:MYERS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12608 STATE ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3208
Mailing Address - Country:US
Mailing Address - Phone:440-230-1960
Mailing Address - Fax:440-230-1965
Practice Address - Street 1:12608 STATE ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44133-3208
Practice Address - Country:US
Practice Address - Phone:440-230-1960
Practice Address - Fax:440-230-1965
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00089011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMYSW30871Medicare ID - Type Unspecified