MEDICARE: DR. MARY KATHRYN BENTON PH.D.

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	4799	OH

General Provider Information

NPI Number	:	1346353620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY KATHRYN BENTON PH.D.

Provider Business Mailing Address
First Line	:	2932 W 14TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-5219
Country	:	US
Telephone Number	:	216-296-4435
Fax Number	:	888-808-4659

Provider Business Practice Location Address
First Line	:	2932 W 14TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-5219
Country	:	US
Telephone Number	:	216-296-4435
Fax Number	:	888-808-4659

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	08/10/2025

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