Provider Demographics
NPI:1184899577
Name:JODY WAINER INCORPORATED
Entity type:Organization
Organization Name:JODY WAINER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAINER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:216-464-6705
Mailing Address - Street 1:3601 GREEN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5725
Mailing Address - Country:US
Mailing Address - Phone:216-464-6705
Mailing Address - Fax:
Practice Address - Street 1:3601 GREEN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5725
Practice Address - Country:US
Practice Address - Phone:216-464-6705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10000385OtherLICENSED INDEPENDENT SOCIAL WORKER
OH1558366831OtherNPI
OHSW22641OtherPTAN