MEDICARE: VIVION FERGUSON

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

General Provider Information

NPI Number	:	1467237602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVION FERGUSON

Provider Business Mailing Address
First Line	:	3639 MOUNT LAUREL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-1328
Country	:	US
Telephone Number	:	216-287-9453
Fax Number	:

Provider Business Practice Location Address
First Line	:	3639 MOUNT LAUREL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-1328
Country	:	US
Telephone Number	:	216-287-9453
Fax Number	:

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

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	08/28/2023

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Directions to “ VIVION FERGUSON ” Practice Location

Language	Start Address	Practice Location

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