Provider Demographics
NPI:1790080315
Name:ABRAHAM, MICHELE ELIZABETH (MSSA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ELIZABETH
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20033 DETROIT RD
Mailing Address - Street 2:201
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2400
Mailing Address - Country:US
Mailing Address - Phone:440-253-9552
Mailing Address - Fax:
Practice Address - Street 1:20033 DETROIT RD
Practice Address - Street 2:201
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-2400
Practice Address - Country:US
Practice Address - Phone:440-253-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0009022SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical