Provider Demographics
NPI:1932674520
Name:AZEM, TALLA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TALLA
Middle Name:
Last Name:AZEM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3690 ORANGE PL STE 430
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4467
Mailing Address - Country:US
Mailing Address - Phone:440-666-1446
Mailing Address - Fax:
Practice Address - Street 1:3690 ORANGE PL STE 430
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4467
Practice Address - Country:US
Practice Address - Phone:216-464-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07714103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical