MEDICARE: PAMELA GLEISSER 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	I0001984	OH

General Provider Information

NPI Number	:	1952492027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA GLEISSER LISW-S

Provider Business Mailing Address
First Line	:	29525 CHAGRIN BLVD
Second Line	:	SUITE 303
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4644
Country	:	US
Telephone Number	:	216-533-1391
Fax Number	:	216-283-9335

Provider Business Practice Location Address
First Line	:	29525 CHAGRIN BLVD
Second Line	:	SUITE 303
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4644
Country	:	US
Telephone Number	:	216-533-1391
Fax Number	:	216-283-9335

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	08/30/2010

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