Mary Ann Teitelbaum, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

4926 Issued in OH

Practice address

5321 Meadow Lane Court, Unit 5
Elyria, OH 44035-0601

Phone

(216) 233-1468

Fax

(440) 277-4401

NPI assigned

Jan 2, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306903349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5321 MEADOW LANE COURT, UNIT 5",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440350601",
            "telephone_number": "216-233-1468",
            "fax_number": "440-277-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5321 MEADOW LANE COURT, UNIT 5",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440350601",
            "telephone_number": "216-233-1468",
            "fax_number": "440-277-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEITELBAUM",
        "first_name": "MARY ANN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "4926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "244073",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0102703",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000138034",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Harold D Tawney
• Dallas Marie Taylor, R.N.
• Holly L Taylor, SLP
• Jasmine R Taylor
• Patricia Taylor, CNP
• Christie Lynn Thacker, LPN
• Kristin Marie Thacker
• The Cleveland Clinic Foundation
• The Cleveland Clinic Foundation
• The Genesis Center

• Psychologist in Elyria, OH
• Providers in Elyria, OH by specialty
• Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.