Individual
DR. ETHAN R BENORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2801 MLK JR DR, CLEVELAND, OH 44104-3815
(216) 448-6253
Mailing address
2801 MLK JR DR, CLEVELAND, OH 44104-3815
(216) 448-6253
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6154
OH
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
6154
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2606326
—
OH
Enumeration date
07/11/2006
Last updated
11/12/2021
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