Healthcare Provider Details

I. General information

NPI: 1477411502
Provider Name (Legal Business Name): JOETTA S BENISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2026
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 BERKELEY RD
CLEVELAND HTS OH
44118-1939
US

IV. Provider business mailing address

3502 BERKELEY RD
CLEVELAND HTS OH
44118-1939
US

V. Phone/Fax

Practice location:
  • Phone: 440-656-7440
  • Fax:
Mailing address:
  • Phone: 440-656-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberSA247095
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: