Provider Demographics
NPI:1649241498
Name:MARIE BIELEFELD PHD ASSOCIATES INC
Entity type:Organization
Organization Name:MARIE BIELEFELD PHD ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIELEFELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:440-734-8164
Mailing Address - Street 1:707 JAYCOX RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2213
Mailing Address - Country:US
Mailing Address - Phone:440-734-8164
Mailing Address - Fax:
Practice Address - Street 1:20325 CENTER RIDGE RD
Practice Address - Street 2:STE 703
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3554
Practice Address - Country:US
Practice Address - Phone:440-734-8164
Practice Address - Fax:216-896-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3779103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH806220Medicaid
OHBICP06284Medicare ID - Type Unspecified