MEDICARE: DR. ADINA RUTH DAVIDSON PHD LISW

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	104100000X	Social Worker	I0007368	OH

General Provider Information

NPI Number	:	1427027606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADINA RUTH DAVIDSON PHD LISW

Provider Business Mailing Address
First Line	:	3681 WINCHELL RD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44122
Country	:	US
Telephone Number	:	216-721-8123
Fax Number	:	216-432-0770

Provider Business Practice Location Address
First Line	:	12429 CEDAR ROAD
Second Line	:	SUITE 21
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44106
Country	:	US
Telephone Number	:	216-721-8123
Fax Number	:	216-432-0770

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/08/2007

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