MEDICARE: PATRICIA LYNN EMERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TM1800X	Intellectual & Developmental Disabilities Psychologist
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1891116489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LYNN EMERSON

Provider Business Mailing Address
First Line	:	2723 ERLENE DR APT 1029
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2858
Country	:	US
Telephone Number	:	513-389-1733
Fax Number	:

Provider Business Practice Location Address
First Line	:	2723 ERLENE DR APT 1029
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2858
Country	:	US
Telephone Number	:	513-389-1733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2013
Last Update Date	:	12/27/2013

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