MEDICARE: ANGELA GRAVES

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	103TM1800X	Intellectual & Developmental Disabilities Psychologist		OH

General Provider Information

NPI Number	:	1477328482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA GRAVES

Provider Business Mailing Address
First Line	:	3554 DALEFORD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-5484
Country	:	US
Telephone Number	:	216-609-9965
Fax Number	:

Provider Business Practice Location Address
First Line	:	3554 DALEFORD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-5484
Country	:	US
Telephone Number	:	216-609-9965
Fax Number	:

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

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	03/24/2025

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Directions to “ ANGELA GRAVES ” Practice Location

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