Provider Demographics
NPI:1992004667
Name:ANGELOPOULOS, MARIAM-MASR DIMITRI (LSW)
Entity Type:Individual
Prefix:MISS
First Name:MARIAM-MASR
Middle Name:DIMITRI
Last Name:ANGELOPOULOS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2773 HAMPSHIRE RD
Mailing Address - Street 2:#7
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2562
Mailing Address - Country:US
Mailing Address - Phone:817-253-6525
Mailing Address - Fax:
Practice Address - Street 1:2773 HAMPSHIRE RD
Practice Address - Street 2:#7
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44106-2562
Practice Address - Country:US
Practice Address - Phone:817-253-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0900853104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS.0900853OtherSOCIAL WORK LICENSE NUMBER