Provider Demographics
NPI:1962853549
Name:GREENWALD, SCOTT HENRY (LISW/LCSW)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:HENRY
Last Name:GREENWALD
Suffix:
Gender:M
Credentials:LISW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7351 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR ON THE LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44060-3125
Mailing Address - Country:US
Mailing Address - Phone:440-290-7383
Mailing Address - Fax:440-953-6129
Practice Address - Street 1:7351 LARKSPUR DR
Practice Address - Street 2:
Practice Address - City:MENTOR ON THE LAKE
Practice Address - State:OH
Practice Address - Zip Code:44060-3125
Practice Address - Country:US
Practice Address - Phone:440-290-7383
Practice Address - Fax:440-953-6129
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-25
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.15005551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical