Provider Demographics
NPI:1871906214
Name:VAYNBERG, OLGA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:VAYNBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 W ASH LN
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4771
Mailing Address - Country:US
Mailing Address - Phone:216-371-7115
Mailing Address - Fax:
Practice Address - Street 1:2405 ROXBORO RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3623
Practice Address - Country:US
Practice Address - Phone:216-371-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1496756103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool