Healthcare Provider Details

I. General information

NPI: 1013998814
Provider Name (Legal Business Name): NANCY DUFF-BOEHM, PH.D., & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26777 LORAIN RD SUITE 716
NORTH OLMSTED OH
44070-3200
US

IV. Provider business mailing address

26777 LORAIN RD SUITE 716
NORTH OLMSTED OH
44070-3200
US

V. Phone/Fax

Practice location:
  • Phone: 440-777-9200
  • Fax: 440-777-9288
Mailing address:
  • Phone: 440-777-9200
  • Fax: 440-777-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3637
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22412
License Number StateOH

VIII. Authorized Official

Name: NANCY J DUFF-BOEHM
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 216-464-5700