Doctor Name: | REGINA WORDSALL |
NPI Number: | 1023346962 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. PSY.S. |
License Number: | |
Business Practice Address: | 23250 Chagrin Blvd Suite 425 Beachwood, OH - 441225470 |
Business Phone Number: | 2164644243 |
Business Fax Number: | 2165958210 |
Mailing Address: | 23250 Chagrin Blvd, Suite 425 BEACHWOOD |
State: | OH |
Postal Code: | 441225470 |
Phone Number: | 2164644243 |
Fax Number: | 2165958210 |
NPI Enumeration Date: | 12/04/2009 |
NPI Last Update Date: | 12/04/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |