MEDICARE: MR. ALAN CHARLES FEDERMAN LSW

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	101YM0800X	Mental Health Counselor	S0013654	OH

General Provider Information

NPI Number	:	1831393545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALAN CHARLES FEDERMAN LSW

Provider Business Mailing Address
First Line	:	3268 EUCLID HEIGHTS BLVD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1859
Country	:	US
Telephone Number	:	216-321-7010
Fax Number	:

Provider Business Practice Location Address
First Line	:	12417 CEDAR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3157
Country	:	US
Telephone Number	:	440-646-8259
Fax Number	:

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	07/08/2007

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