Provider Demographics
NPI:1386067106
Name:STOOPS, CAROLYN (PSY S,)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:STOOPS
Suffix:
Gender:F
Credentials:PSY S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37047 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4130
Mailing Address - Country:US
Mailing Address - Phone:440-946-5000
Mailing Address - Fax:440-946-4671
Practice Address - Street 1:37047 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4130
Practice Address - Country:US
Practice Address - Phone:440-946-5000
Practice Address - Fax:440-946-4671
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3083811174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist