MEDICARE: DR. GARY E CARRINGTON PHD

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	101Y00000X	Counselor	E2705	OH
2	103TC0700X	Clinical Psychologist	6733	OH

General Provider Information

NPI Number	:	1164614103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY E CARRINGTON PHD

Provider Business Mailing Address
First Line	:	1282 CLEVELAND HTS BLVD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44121-1659
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25101 CHAGRIN BLVD
Second Line	:	SUITE 100
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5643
Country	:	US
Telephone Number	:	216-831-6611
Fax Number	:	251-456-8128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	02/10/2016

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