MEDICARE: JOETTA S BENISON

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	103TH0100X	Health Service Psychologist	SA247095	OH

General Provider Information

NPI Number	:	1477411502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOETTA S BENISON

Provider Business Mailing Address
First Line	:	3502 BERKELEY RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-1939
Country	:	US
Telephone Number	:	440-656-7440
Fax Number	:

Provider Business Practice Location Address
First Line	:	3502 BERKELEY RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-1939
Country	:	US
Telephone Number	:	440-656-7440
Fax Number	:

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

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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Directions to “ JOETTA S BENISON ” Practice Location

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