MEDICARE: ERIN LUNGREN PSYD

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	2080P0006X	Developmental - Behavioral Pediatrics Physician	7330	OH

General Provider Information

NPI Number	:	1578930780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN LUNGREN PSYD

Provider Business Mailing Address
First Line	:	20800 HARVARD RD
Second Line	:	2ND FLR
City	:	HIGHLAND HILLS
State	:	OH
Zip	:	44122-7202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1716
Country	:	US
Telephone Number	:	216-844-7700
Fax Number	:

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

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/24/2015

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