| Doctor Name: | MICHELLE MONICA HARTIS |
| NPI Number: | 1063409787 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | I8651 |
| Business Practice Address: | 202 E Bagley Rd Berea, OH - 440172058 |
| Business Phone Number: | 4402608228 |
| Business Fax Number: | |
| Mailing Address: | 994 Caxton Ln, BRUNSWICK |
| State: | OH |
| Postal Code: | 442126478 |
| Phone Number: | 3306354940 |
| Fax Number: | |
| NPI Enumeration Date: | 09/29/2005 |
| NPI Last Update Date: | 07/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | I8651 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |