Provider Demographics
NPI:1649587502
Name:GARRETT, ELIZABETH L (LISW-S)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:L
Other - Last Name:FEROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-S
Mailing Address - Street 1:25201 CHAGRIN BLVD STE 390
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5637
Mailing Address - Country:US
Mailing Address - Phone:216-220-3100
Mailing Address - Fax:216-706-2632
Practice Address - Street 1:25201 CHAGRIN BLVD STE 390
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5637
Practice Address - Country:US
Practice Address - Phone:216-220-3100
Practice Address - Fax:216-706-2632
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00296811041C0700X
OHI.0029681-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid