Provider Information for 1801976634
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STEPHANIE L KIDD MA, MED, LPCC/PCC
Other Names:Former Name:STEPHANIE L BIRNBAUM MA, MED, LPCC/PCCSex: Female
NPI: 1801976634
Last Updated: 2014-10-23
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||||||
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| NPI | 1801976634 | ||||||||||||||||||||
| Enumeration Date | 2006-10-16 | ||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||||||
| Status | Active | ||||||||||||||||||||
| Mailing Address | 6929 W 130TH ST SUITE 503 CLEVELAND, OH 44130-7895 United States Phone: 440-481-3055 | Fax:440-481-3222 | ||||||||||||||||||||
| Primary Practice Address | 6929 W 130TH ST SUITE 503 CLEVELAND, OH 44130-7895 United States Phone: 440-481-3055 | Fax:440-481-3222 | ||||||||||||||||||||
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