MEDICARE: DR. SUSAN RADBOURNE 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	103TC1900X	Counseling Psychologist	5776	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	:	1760550099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN RADBOURNE PH.D.

Provider Business Mailing Address
First Line	:	5851 PEARL RD
Second Line	:	SUITE 305
City	:	CLEVELAND
State	:	OH
Zip	:	44130-2112
Country	:	US
Telephone Number	:	440-845-9011
Fax Number	:	440-845-9013

Provider Business Practice Location Address
First Line	:	5851 PEARL RD
Second Line	:	SUITE 305
City	:	CLEVELAND
State	:	OH
Zip	:	44130-2112
Country	:	US
Telephone Number	:	440-845-9011
Fax Number	:	440-845-9013

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	02/03/2011

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