MEDICARE: MISS SHANICE LAUB PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	106S00000X	Behavior Technician
2	171M00000X	Case Manager/Care Coordinator	CA
3	222Q00000X	Developmental Therapist
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1992162861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHANICE LAUB PSYD

Provider Business Mailing Address
First Line	:	12608 STATE RD STE 1
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-3281
Country	:	US
Telephone Number	:	440-907-1141
Fax Number	:	440-345-3456

Provider Business Practice Location Address
First Line	:	12608 STATE RD STE 1
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-3281
Country	:	US
Telephone Number	:	216-907-1141
Fax Number	:	440-345-3456

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

Provider Enumeration Date	:	01/24/2016
Last Update Date	:	08/08/2025

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