Individual
REBECCA A HAZEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
11100 EUCLID AVENUE, CLEVELAND, OH 44106
(216) 844-7700
(216) 286-6341
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
6398
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000229448
UNISON
OH
05
—
1021091480001
—
PA
05
—
2787113
—
OH
01
—
421801
WELLCARE
OH
01
—
9229116
AETNA
OH
Enumeration date
09/26/2007
Last updated
07/06/2011
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