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NPI Code Detail

MEDICARE: SEAN BOETCHER

MEDICARE: SEAN BOETCHER
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
1103TS0200XSchool PsychologistOH3129679OH

General Provider Information

NPI Number : 1770984288
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEAN BOETCHER
Provider Business Mailing Address
First Line : 1349 E 79TH ST
Second Line : OFFICE OF PSYCHOLOGICAL SERVICES
City : CLEVELAND
State : OH
Zip : 44103-2864
Country : US
Telephone Number : 216-307-4210
Fax Number :
Provider Business Practice Location Address
First Line : 1349 E 79TH ST
Second Line : OFFICE OF PSYCHOLOGICAL SERVICES
City : CLEVELAND
State : OH
Zip : 44103-2864
Country : US
Telephone Number : 216-307-4210
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2014
Last Update Date : 09/16/2014

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Directions to “ SEAN BOETCHER ” Practice Location

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