MEDICARE: STEAM ACADEMY OF WARRENSVILLE HEIGHTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1083004642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEAM ACADEMY OF WARRENSVILLE HEIGHTS

Provider Business Mailing Address
First Line	:	4700 RICHMOND RD
Second Line	:	SUITE 3000
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-5984
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 RICHMOND RD
Second Line	:	SUITE 3000
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-5984
Country	:	US
Telephone Number	:	216-595-2866
Fax Number	:

Authorized Official
Title or Position	:	HEAD OF SCHOOL/PRINCIPAL
Name	:	GARY LANE
Credential	:
Telephone Number	:	216-595-2866

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	02/03/2015

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