Provider Demographics
NPI:1629208665
Name:BEN PORATH, DENISE (PHD)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:BEN PORATH
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 1:25550 CHAGRIN BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5638
Mailing Address - Country:US
Mailing Address - Phone:216-765-0500
Mailing Address - Fax:216-765-0521
Practice Address - Street 1:25550 CHAGRIN BLVD
Practice Address - Street 2:STE 200
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5638
Practice Address - Country:US
Practice Address - Phone:216-765-0500
Practice Address - Fax:216-765-0521
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical