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NPI Code Detail

MEDICARE: ELIZABETH N RICHMOND PCC-S

MEDICARE: ELIZABETH N RICHMOND PCC-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
1101YP2500XProfessional CounselorC007678OH

General Provider Information

NPI Number : 1891919841
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH N RICHMOND PCC-S
Provider Business Mailing Address
First Line : 12200 FAIRHILL RD
Second Line : C248
City : CLEVELAND
State : OH
Zip : 44120-1058
Country : US
Telephone Number : 216-375-5608
Fax Number : 216-325-7785
Provider Business Practice Location Address
First Line : 12200 FAIRHILL RD
Second Line : C248
City : CLEVELAND
State : OH
Zip : 44120-1058
Country : US
Telephone Number : 216-375-5608
Fax Number : 216-325-7785
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2007
Last Update Date : 06/08/2010

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