Provider Demographics
NPI:1215989033
Name:THATCHER-BENZA, AMY (PHD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:THATCHER-BENZA
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 1:4018 MEDINA RD STE D
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9675
Mailing Address - Country:US
Mailing Address - Phone:330-722-4166
Mailing Address - Fax:330-725-5792
Practice Address - Street 1:4018 MEDINA RD STE D
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9675
Practice Address - Country:US
Practice Address - Phone:330-722-4166
Practice Address - Fax:330-725-5792
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2348270Medicaid
OHTHCP28751Medicare ID - Type Unspecified