MEDICARE: BARNETT D. ELMAN PH.D.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	862233	OH
2	101YP2500X	Professional Counselor	E-1012	OH
3	103TC1900X	Counseling Psychologist	5525	OH

General Provider Information

NPI Number	:	1851408553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARNETT D. ELMAN PH.D.

Provider Business Mailing Address
First Line	:	5564 WILSON MILLS ROAD
Second Line	:	SUITE 201
City	:	HIGHLAND HEIGHTS
State	:	OH
Zip	:	44143-3265
Country	:	US
Telephone Number	:	440-461-1255
Fax Number	:	440-461-1047

Provider Business Practice Location Address
First Line	:	5564 WILSON MILLS RD
Second Line	:	SUITE 201
City	:	HIGHLAND HEIGHTS
State	:	OH
Zip	:	44143-3265
Country	:	US
Telephone Number	:	440-461-1255
Fax Number	:	440-461-1047

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	11/07/2007

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