| Doctor Name: | ALISSA E FADEM |
| NPI Number: | 1144510132 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PC |
| License Number: | C.0800437 |
| Business Practice Address: | 22001 Fairmount Blvd Shaker Hts, OH - 441184819 |
| Business Phone Number: | 2163208485 |
| Business Fax Number: | 2163208753 |
| Mailing Address: | 1396 Gordon Rd, LYNDHURST |
| State: | OH |
| Postal Code: | 441241350 |
| Phone Number: | 3302210118 |
| Fax Number: | |
| NPI Enumeration Date: | 04/12/2011 |
| NPI Last Update Date: | 04/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | C.0800437 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |