Provider Demographics
NPI:1679898365
Name:LANDEVER, MARJORIE (LISW - S)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:LANDEVER
Suffix:
Gender:F
Credentials:LISW - S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39244
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-0244
Mailing Address - Country:US
Mailing Address - Phone:216-534-9404
Mailing Address - Fax:
Practice Address - Street 1:99 ASHLAND LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8858
Practice Address - Country:US
Practice Address - Phone:216-534-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 00091271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical