Healthcare Provider Details

I. General information

NPI: 1073575106
Provider Name (Legal Business Name): NEUROPSYCHOLOGY AND PSYCHOTHERAPY SERVICES OF CLEVELAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 GREEN RD STE 218
BEACHWOOD OH
44122-5719
US

IV. Provider business mailing address

23811 CHAGRIN BLVD STE 307
BEACHWOOD OH
44122-5525
US

V. Phone/Fax

Practice location:
  • Phone: 216-595-8900
  • Fax: 216-595-0088
Mailing address:
  • Phone: 216-595-8900
  • Fax: 216-595-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: BARRY S LAYTON
Title or Position: OWNER
Credential: PHD
Phone: 216-595-8900