Healthcare Provider Details

I. General information

NPI: 1336205590
Provider Name (Legal Business Name): MEMORY & PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8180 BRECKSVILLE RD STE 115
BRECKSVILLE OH
44141-1353
US

IV. Provider business mailing address

8180 BRECKSVILLE RD STE 115
BRECKSVILLE OH
44141-1353
US

V. Phone/Fax

Practice location:
  • Phone: 440-546-0048
  • Fax: 888-828-2326
Mailing address:
  • Phone: 440-546-0048
  • Fax: 888-828-2326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6017
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6017
License Number StateOH

VIII. Authorized Official

Name: CATHERINE WHEATLEY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 440-546-0048