Individual ProviderAmy Phelan Smith TysonSocial WorkerBehavioral Health & Social Service ProvidersPractice Address22001 Fairmount Blvd, Shaker Heights, OH 44118-4819(216) 320-8293(612) 578-2435PECOS EnrollmentBased on the most recent information from CMS, provider Amy Phelan Smith Tyson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1215249420Provider TypeIndividualFull NameTyson, Amy Phelan SmithTitleMrs.CredentialLISW-SGenderFemaleSole ProprietorYesEnumeration Date7/6/2010Last Updated12/15/2010Contact InformationPractice LocationPractice Address22001 Fairmount Blvd, Shaker Heights, OH 44118-4819Phone(216) 320-8293FaxUnlisted FaxMailing LocationMailing Address1113 S Belvoir Blvd, South Euclid, OH 44121-2946Phone(612) 578-2435FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseI.0900275-SUPVOhioCode1041C0700XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseI.0900275Ohio