Provider Demographics
NPI:1285997528
Name:GEBREMICAEL, GEBREMARIAM ALEM
Entity type:Individual
Prefix:MR
First Name:GEBREMARIAM
Middle Name:ALEM
Last Name:GEBREMICAEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GENERAL DELIVERY
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-9999
Mailing Address - Country:US
Mailing Address - Phone:651-500-1354
Mailing Address - Fax:
Practice Address - Street 1:2120 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3378
Practice Address - Country:US
Practice Address - Phone:612-872-2000
Practice Address - Fax:612-871-1375
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker