Basic Information
| Provider Information | |||||||||
| NPI: | 1962750448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEDERMAN | ||||||||
| FirstName: | DEVORAH | ||||||||
| MiddleName: | MIRIAM | ||||||||
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| Credential: | L.S.W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2250 WATERS EDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432093333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128340395 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1490 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432052140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142520731 | ||||||||
| FaxNumber: | 6142528468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2012 | ||||||||
| LastUpdateDate: | 08/15/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1101211 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.