Basic Information
| Provider Information | |||||||||
| NPI: | 1568712503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BILECI | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | A | ||||||||
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| NameSuffix: | |||||||||
| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5930 HEISLEY RD | ||||||||
| Address2: | |||||||||
| City: | MENTOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440601834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406392509 | ||||||||
| FaxNumber: | 4403522040 | ||||||||
| Practice Location | |||||||||
| Address1: | 5930 HEISLEY RD | ||||||||
| Address2: | |||||||||
| City: | MENTOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440601834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406392509 | ||||||||
| FaxNumber: | 4403522040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 09/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I1100016 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 2362429 | 05 | OH | MEDICAID |