MEDICARE: MRS. MARLENE A SORAH MS

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	101YM0800X	Mental Health Counselor	E0002155	OH

General Provider Information

NPI Number	:	1043298235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARLENE A SORAH MS

Provider Business Mailing Address
First Line	:	1 ELIZABETH PL STE 111
Second Line	:	1195 B MEADOW BRIDGE DRIVE
City	:	DAYTON
State	:	OH
Zip	:	45408-1445
Country	:	US
Telephone Number	:	937-228-0579
Fax Number	:	937-228-0592

Provider Business Practice Location Address
First Line	:	1 ELIZABETH PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45408-1445
Country	:	US
Telephone Number	:	937-228-0579
Fax Number	:	937-228-0592

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	01/18/2008

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