Provider Demographics
NPI:1427484914
Name:VONBOESELAGER, ERICH JOSEF (PC)
Entity type:Individual
Prefix:
First Name:ERICH
Middle Name:JOSEF
Last Name:VONBOESELAGER
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 MEADOWBROOK BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2951
Mailing Address - Country:US
Mailing Address - Phone:216-443-3358
Mailing Address - Fax:216-631-3654
Practice Address - Street 1:7800 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2814
Practice Address - Country:US
Practice Address - Phone:216-939-3709
Practice Address - Fax:216-631-3654
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-C.120005.PROV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health