Healthcare Provider Details

I. General information

NPI: 1851795272
Provider Name (Legal Business Name): ROBERT NORTON PSY S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11104 WADE PARK AVE
CLEVELAND OH
44106-3908
US

IV. Provider business mailing address

11104 WADE PARK AVE
CLEVELAND OH
44106-3908
US

V. Phone/Fax

Practice location:
  • Phone: 216-404-9579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP.00650
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOH3100126
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: