Provider Demographics
NPI:1700065539
Name:VERBA, JUDITH H (LISW)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:H
Last Name:VERBA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 FAIRHILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1053
Mailing Address - Country:US
Mailing Address - Phone:216-373-1788
Mailing Address - Fax:216-373-8014
Practice Address - Street 1:11900 FAIRHILL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1053
Practice Address - Country:US
Practice Address - Phone:216-373-1788
Practice Address - Fax:216-373-8014
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
9235411OtherMEDICARE B
OH0959539Medicaid