Provider Demographics
NPI:1013347137
Name:KHAFAGA, MERVAT M (LISW)
Entity type:Individual
Prefix:MRS
First Name:MERVAT
Middle Name:M
Last Name:KHAFAGA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3304
Mailing Address - Country:US
Mailing Address - Phone:216-631-5800
Mailing Address - Fax:216-631-4595
Practice Address - Street 1:4115 BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3304
Practice Address - Country:US
Practice Address - Phone:216-631-5800
Practice Address - Fax:216-631-4595
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.12012921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical