Healthcare Provider Details

I. General information

NPI: 1376758565
Provider Name (Legal Business Name): MYCHAIL B SCHERAMIC PSY.D., MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 DETROIT AVE. AT RIVER RD.
MAUMEE OH
43537
US

IV. Provider business mailing address

330 LOUISIANA AVE STE A
PERRYSBURG OH
43551-1470
US

V. Phone/Fax

Practice location:
  • Phone: 419-277-7733
  • Fax:
Mailing address:
  • Phone: 419-874-9488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4361
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4631
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number4631
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4631
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4631
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number4631
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number4631
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number4631
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number4631
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4631
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: