Healthcare Provider Details

I. General information

NPI: 1447190863
Provider Name (Legal Business Name): BENJAMIN PAUL SCHADE LSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9826 WASHINGTON ST
CHAGRIN FALLS OH
44023-5401
US

IV. Provider business mailing address

2595 TOWNLINE RD
MADISON OH
44057-2342
US

V. Phone/Fax

Practice location:
  • Phone: 440-708-0188
  • Fax:
Mailing address:
  • Phone: 330-979-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP.00761
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: