Provider Demographics
NPI:1700849536
Name:RIDGE, SHARI (PHD)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:
Last Name:RIDGE
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 1:34900 CHARDON RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9161
Mailing Address - Country:US
Mailing Address - Phone:440-951-5600
Mailing Address - Fax:440-951-1293
Practice Address - Street 1:35000 CHARDON RD
Practice Address - Street 2:210
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9012
Practice Address - Country:US
Practice Address - Phone:440-951-5600
Practice Address - Fax:440-951-1293
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4494103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHR71959Medicare UPIN
OHRIP11397Medicare ID - Type Unspecified