Beach Glass Psychology LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

BEACH GLASS PSYCHOLOGY LLC

Practice address

37000 Center Ridge Road
Suite 3 Lower Level
North Ridgeville, OH 44039-2804

Phone

(440) 570-5458

Fax

(440) 628-2422

NPI assigned

Jul 23, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Ann Marie Yezzi-Shareef, PHD

Title

Psychologist

Phone

(440) 570-5458

Specialties & licenses 4

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614038400000",
    "number": "1891348405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36144 CENTER RIDGE RD",
            "city": "NORTH RIDGEVILLE",
            "state": "OH",
            "postal_code": "440392938",
            "telephone_number": "440-570-5458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37000 CENTER RIDGE ROAD",
            "address_2": "SUITE 3 LOWER LEVEL",
            "city": "NORTH RIDGEVILLE",
            "state": "OH",
            "postal_code": "440392804",
            "telephone_number": "440-570-5458",
            "fax_number": "440-628-2422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACH GLASS PSYCHOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-23",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A",
        "authorized_official_last_name": "YEZZI-SHAREEF",
        "authorized_official_first_name": "ANN MARIE",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "440-570-5458",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TA0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Adult Development & Aging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0247177",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in North Ridgeville, OH
• Providers in North Ridgeville, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; 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.