Healthcare Provider Details

I. General information

NPI: 1821006156
Provider Name (Legal Business Name): CYNTHIA P VANKEUREN PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24400 HIGHPOINT RD STE # 6
BEACHWOOD OH
44122
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-6550
  • Fax: 216-831-6133
Mailing address:
  • Phone: 216-445-1108
  • Fax: 216-444-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number6104
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number6104
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: