MEDICARE: DR. CAROLEE KUHNS LESYK 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	103TC0700X	Clinical Psychologist	2276	OH

General Provider Information

NPI Number	:	1679642581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLEE KUHNS LESYK PH.D.

Provider Business Mailing Address
First Line	:	32 SUGARBUSH LANE
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-4109
Country	:	US
Telephone Number	:	440-338-4816
Fax Number	:	440-338-6704

Provider Business Practice Location Address
First Line	:	2460 FAIRMOUNT BLVD STE 209
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3125
Country	:	US
Telephone Number	:	216-229-4020
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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