Provider Demographics
NPI:1376326322
Name:MOON, LAINE HOPE (MED, EDS)
Entity Type:Individual
Prefix:MRS
First Name:LAINE
Middle Name:HOPE
Last Name:MOON
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:MS
Other - First Name:LAINE
Other - Middle Name:H
Other - Last Name:BAIZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:5983 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-3854
Mailing Address - Country:US
Mailing Address - Phone:216-296-0336
Mailing Address - Fax:
Practice Address - Street 1:5983 W 54TH ST
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-3854
Practice Address - Country:US
Practice Address - Phone:216-296-0336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3359459103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool