MEDICARE: CHAVA EMMA HARRIS LISW-S

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	1041C0700X	Clinical Social Worker	I.1000021	OH

General Provider Information

NPI Number	:	1730480138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAVA EMMA HARRIS LISW-S

Provider Business Mailing Address
First Line	:	PO BOX 221261
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-0996
Country	:	US
Telephone Number	:	216-970-0732
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 FAIRMOUNT BLVD STE 320
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3164
Country	:	US
Telephone Number	:	216-970-0732
Fax Number	:

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

Provider Enumeration Date	:	11/16/2010
Last Update Date	:	01/30/2018

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