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General NPI Number Information
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NPI Number | 1528205655
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Entity Type | Individual
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Provider Name | MICHELE PATAK-PIETRAFESA MSW, LISW-S
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Gender | Female
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 3840 N HIGH ST STE D
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City | COLUMBUS
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State | OH
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Zip | 43214-3761
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Country | US
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Telephone | 614-450-2155
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Fax | 614-675-2216
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Provider Business Mailing Address
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Address Line | 300 E KANAWHA AVE
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City | COLUMBUS
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State | OH
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Zip | 43214-1212
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Country | US
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Telephone | 614-450-2155
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Fax | 614-675-2216
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | I.1303088
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | S.0701361-TRNE
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1303088.SUPV
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License Number State | OH
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