MEDICARE: MISS MARIAM-MASR DIMITRI ANGELOPOULOS 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	104100000X	Social Worker	S.0900853	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S.0900853	OTHER	OH	SOCIAL WORK LICENSE NUMBER

General Provider Information

NPI Number	:	1992004667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIAM-MASR DIMITRI ANGELOPOULOS LSW

Provider Business Mailing Address
First Line	:	2773 HAMPSHIRE RD
Second Line	:	#7
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44106-2562
Country	:	US
Telephone Number	:	817-253-6525
Fax Number	:

Provider Business Practice Location Address
First Line	:	2773 HAMPSHIRE RD
Second Line	:	#7
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44106-2562
Country	:	US
Telephone Number	:	817-253-6525
Fax Number	:

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

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	03/24/2011

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Directions to “ MISS MARIAM-MASR DIMITRI ANGELOPOULOS LSW” Practice Location

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