Provider Demographics
NPI:1770800658
Name:CODY, AMY MARIE DILLON (MSW, LISW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE DILLON
Last Name:CODY
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, LSW
Mailing Address - Street 1:1242 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2230
Mailing Address - Country:US
Mailing Address - Phone:216-409-7657
Mailing Address - Fax:
Practice Address - Street 1:24481 DETROIT RD STE 201
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1557
Practice Address - Country:US
Practice Address - Phone:440-381-8240
Practice Address - Fax:440-625-2592
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1000751104100000X
171M00000X
OHI.20023001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0290822Medicaid