Healthcare Provider Details

I. General information

NPI: 1629480348
Provider Name (Legal Business Name): KAREN GEBHARDT PSY.S.,NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11005 PARKHURST DR
CLEVELAND OH
44111-3601
US

IV. Provider business mailing address

7616 DEERFIELD DR
PARMA OH
44129-4432
US

V. Phone/Fax

Practice location:
  • Phone: 216-476-4200
  • Fax:
Mailing address:
  • Phone: 440-520-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH1200517
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: