Individual provider Active NPI

Suzanne H Hetrick, PHD

  • Psychologist
  • Stow, OH
National Provider Identifier
1225095805
Registry record updated Dec 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
4833 Darrow Road Suite 101
Stow, OH 44224-1411
Phone
(330) 650-5338
Fax
(330) 342-3837
NPI assigned
Apr 27, 2006
Last updated
Dec 8, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X Primary
Cognitive & Behavioral Psychologist 103TB0200X 338 OH
Clinical Child & Adolescent Psychologist 103TC2200X 338 OH
Family Psychologist 103TF0000X 338 OH

Addresses

Primary practice location

4833 Darrow Road Suite 101
Stow, OH 44224-1411

Mailing address

4833 Darrow Road Suite 101
Stow, OH 44224-1411
Phone (330) 650-5338

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291766400000",
    "number": "1225095805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4833 DARROW ROAD SUITE 101",
            "city": "STOW",
            "state": "OH",
            "postal_code": "442241411",
            "telephone_number": "330-650-5338",
            "fax_number": "330-342-3837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4833 DARROW ROAD SUITE 101",
            "city": "STOW",
            "state": "OH",
            "postal_code": "442241411",
            "telephone_number": "330-650-5338",
            "fax_number": "330-342-3837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HETRICK",
        "first_name": "SUZANNE",
        "middle_name": "H",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2010-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "OH",
            "license": "338",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "OH",
            "license": "338",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "OH",
            "license": "338",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stow, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.