MEDICARE: FRANK EZZO 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	103TC0700X	Clinical Psychologist	3065	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000391242	OTHER	OH	ANTHEM BLUE CROSS PIN

General Provider Information

NPI Number	:	1841249505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK EZZO PH.D.

Provider Business Mailing Address
First Line	:	23811 CHAGRIN BLVD
Second Line	:	SUITE 310
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5525
Country	:	US
Telephone Number	:	216-464-1277
Fax Number	:	216-464-9109

Provider Business Practice Location Address
First Line	:	23811 CHAGRIN BLVD
Second Line	:	SUITE 310
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5525
Country	:	US
Telephone Number	:	216-464-1277
Fax Number	:	216-464-9109

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	11/28/2016

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Directions to “ FRANK EZZO PH.D.” Practice Location

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