Individual provider Active NPI

Mary Ann Kraus, PSY.D.

  • Psychologist
  • Beachwood, OH
National Provider Identifier
1366521890
Registry record updated Jan 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
4009 Issued in OH
Practice address
21403 Chagrin Blvd
Suite 210
Beachwood, OH 44122-5322
Phone
(216) 406-8987
NPI assigned
Nov 3, 2006
Last updated
Jan 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 4009 OH Primary

Addresses

Primary practice location

21403 Chagrin Blvd
Suite 210
Beachwood, OH 44122-5322

Mailing address

21403 Chagrin Blvd
Suite 210
Beachwood, OH 44122-5322
Phone (216) 406-8987

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20060411000019 OH Practitioner - Clinical Psychologist 4688683212 Practice locations: Beachwood, OH

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4009OHMDChiropractor

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674777600000",
    "number": "1366521890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21403 CHAGRIN BLVD",
            "address_2": "SUITE 210",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225322",
            "telephone_number": "216-406-8987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21403 CHAGRIN BLVD",
            "address_2": "SUITE 210",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225322",
            "telephone_number": "216-406-8987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAUS",
        "first_name": "MARY ANN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-03",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "4009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beachwood, OH

Sources for this page

Verify at the official NPI Registry.