MEDICARE: DR. KENNETH GERSTENHABER PH.D

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	103TB0200X	Cognitive & Behavioral Psychologist	2995	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245292127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH GERSTENHABER PH.D

Provider Business Mailing Address
First Line	:	5035 MAYFIELD RD
Second Line	:	212
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2688
Country	:	US
Telephone Number	:	216-292-9306
Fax Number	:	216-464-3950

Provider Business Practice Location Address
First Line	:	5035 MAYFIELD RD
Second Line	:	212
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2688
Country	:	US
Telephone Number	:	216-292-9306
Fax Number	:	216-464-3950

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	12/04/2012

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