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General NPI Number Information
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NPI Number | 1225624067
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Entity Type | Individual
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Provider Name | ELYSE CARMAN
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Gender | Female
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 11565 PEARL RD STE 200
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City | STRONGSVILLE
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State | OH
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Zip | 44136-3356
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Country | US
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Telephone | 440-452-6504
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Fax |
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Provider Business Mailing Address
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Address Line | 114 REGENCY CT
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City | ELYRIA
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State | OH
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Zip | 44035-1770
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Country | US
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Telephone | 440-452-6504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | S.1200058
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | S.1200058
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License Number State | OH
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