MEDICARE: DR. CHERYL ANN CHASE PHD

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	6275	OH

General Provider Information

NPI Number	:	1851408306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL ANN CHASE PHD

Provider Business Mailing Address
First Line	:	7758 OAKHURST CIR
Second Line	:
City	:	BRECKSVILLE
State	:	OH
Zip	:	44141-1122
Country	:	US
Telephone Number	:	216-401-6061
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 OAK TREE BLVD
Second Line	:	STE 200
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2544
Country	:	US
Telephone Number	:	216-328-2045
Fax Number	:

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	08/26/2012

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