MEDICARE: DR. PAULA MICKENS-ENGLISH PH.D

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	103TC1900X	Counseling Psychologist	5460	OH

General Provider Information

NPI Number	:	1255441648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA MICKENS-ENGLISH PH.D

Provider Business Mailing Address
First Line	:	2490 LEE BLVD
Second Line	:	#102
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1268
Country	:	US
Telephone Number	:	216-371-1991
Fax Number	:

Provider Business Practice Location Address
First Line	:	2490 LEE BLVD
Second Line	:	#102
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1268
Country	:	US
Telephone Number	:	216-371-1991
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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