Provider Demographics
NPI:1487076964
Name:DIEDRICK, BARBARA A (PHD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:DIEDRICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:A,
Other - Last Name:CHAPPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25101 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5643
Mailing Address - Country:US
Mailing Address - Phone:216-831-6611
Mailing Address - Fax:216-456-8128
Practice Address - Street 1:4212 OHIO STATE ROUTE 306
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9446
Practice Address - Country:US
Practice Address - Phone:216-831-6611
Practice Address - Fax:216-456-8128
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7093103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical