Provider Demographics
NPI:1033314562
Name:ROSCH EIFERT, DEBORAH STAELENS (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:STAELENS
Last Name:ROSCH EIFERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3134
Mailing Address - Country:US
Mailing Address - Phone:216-409-9785
Mailing Address - Fax:
Practice Address - Street 1:22540 LORAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2212
Practice Address - Country:US
Practice Address - Phone:440-734-4037
Practice Address - Fax:440-734-4710
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5271103TC0700X, 103TF0200X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHROCP77413Medicare UPIN