Healthcare Provider Details

I. General information

NPI: 1568776987
Provider Name (Legal Business Name): ANDREA STEPHENSON BURLAND PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA STEPHENSON PH.D.

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 GREEN RD STE 120
BEACHWOOD OH
44122
US

IV. Provider business mailing address

3659 GREEN RD STE 120
BEACHWOOD OH
44122-5715
US

V. Phone/Fax

Practice location:
  • Phone: 440-836-4723
  • Fax:
Mailing address:
  • Phone: 440-836-4723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6531
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6531
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: