MEDICARE: IRINA BRANSTETER 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	103TC1900X	Counseling Psychologist	7667	OH

General Provider Information

NPI Number	:	1689187353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA BRANSTETER PH. D.

Provider Business Mailing Address
First Line	:	10524 EUCLID AVE STE 1155
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10524 EUCLID AVE STE 1155
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2205
Country	:	US
Telephone Number	:	216-844-3881
Fax Number	:

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

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	01/07/2021

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