MEDICARE: DR. SUZANNE G BENNY 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	103T00000X	Psychologist	5934	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306818430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE G BENNY PHD

Provider Business Mailing Address
First Line	:	PO BOX 24242
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-0242
Country	:	US
Telephone Number	:	216-839-2273
Fax Number	:	216-896-0735

Provider Business Practice Location Address
First Line	:	7040 HEPBURN RD
Second Line	:
City	:	MIDDLEBURG HTS
State	:	OH
Zip	:	44130
Country	:	US
Telephone Number	:	216-410-8664
Fax Number	:

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	08/09/2018

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