Healthcare Provider Details

I. General information

NPI: 1457107344
Provider Name (Legal Business Name): DRADRIANECOM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6575 STRATHMORE DR
CLEVELAND OH
44125-5514
US

IV. Provider business mailing address

PO BOX 660
MENTOR OH
44061-0660
US

V. Phone/Fax

Practice location:
  • Phone: 440-668-7772
  • Fax:
Mailing address:
  • Phone: 440-854-0217
  • Fax: 440-516-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: ADRIANE BENNETT
Title or Position: OWNER
Credential:
Phone: 440-668-7772