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General NPI Number Information
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NPI Number | 1740790252
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Entity Type | Organization
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Legal Business Name | LAKEFRONT PSYCHOLOGY
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 1991 CROCKER RD STE 604
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City | WESTLAKE
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State | OH
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Zip | 44145-6969
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Country | US
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Telephone | 216-870-9816
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Fax |
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Provider Business Mailing Address
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Address Line | 31729 TRADEWINDS DR
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City | AVON LAKE
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State | OH
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Zip | 44012-2916
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Country | US
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Telephone | 216-870-9814
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/OWNER
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Name | DR. SUZANNE JEAN SMITH
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Credential | PH.D.
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Telephone | 216-870-9816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 6103
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License Number State | OH
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