MEDICARE: OLGA VAYNBERG

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	103TS0200X	School Psychologist	1496756	OH

General Provider Information

NPI Number	:	1871906214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA VAYNBERG

Provider Business Mailing Address
First Line	:	4000 W ASH LN
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4771
Country	:	US
Telephone Number	:	216-371-7115
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 ROXBORO RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44106-3623
Country	:	US
Telephone Number	:	216-371-7115
Fax Number	:

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

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	06/03/2014

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Directions to “ OLGA VAYNBERG ” Practice Location

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