MEDICARE: MICHELE ELIZABETH ABRAHAM M.S.S.A.

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	I0009022SUPV	OH

General Provider Information

NPI Number	:	1790080315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE ELIZABETH ABRAHAM M.S.S.A.

Provider Business Mailing Address
First Line	:	20033 DETROIT RD
Second Line	:	201
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-2400
Country	:	US
Telephone Number	:	440-253-9552
Fax Number	:

Provider Business Practice Location Address
First Line	:	20033 DETROIT RD
Second Line	:	201
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-2400
Country	:	US
Telephone Number	:	440-253-9552
Fax Number	:

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

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	01/12/2011

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