| NPI | 1518643550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SULLIVAN Credentialing Specialist 440-453-0754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2024-01-31 |