MEDICARE: LAURA M HANCOCK PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	3294	WI
2	103TC0700X	Clinical Psychologist	P.08442	OH
3	103G00000X	Clinical Neuropsychologist	P.08442	OH

General Provider Information

NPI Number	:	1114233921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA M HANCOCK PHD

Provider Business Mailing Address
First Line	:	9600 EUCLID AVE # S31
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE # S31
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-5105
Country	:	US
Telephone Number	:	216-445-1637
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	04/25/2023

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