MEDICARE: ANGELA L MERRIWEATHER CDCA PEER SPECIALIST

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.186659	OH
2	171M00000X	Case Manager/Care Coordinator
3	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1407322886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA L MERRIWEATHER CDCA PEER SPECIALIST

Provider Business Mailing Address
First Line	:	600 SUPERIOR AVE E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2614
Country	:	US
Telephone Number	:	216-220-8774
Fax Number	:

Provider Business Practice Location Address
First Line	:	8235 GREEN DR
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2057
Country	:	US
Telephone Number	:	216-269-7643
Fax Number	:

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

Provider Enumeration Date	:	10/23/2018
Last Update Date	:	11/08/2024

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