Healthcare Provider Details

I. General information

NPI: 1518098334
Provider Name (Legal Business Name): PSYCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 WESTCHESTER DRIVE SUITE 5
AUSTINTOWN OH
44515
US

IV. Provider business mailing address

136 WESTCHESTER DRIVE SUITE 5
AUSTINTOWN OH
44515
US

V. Phone/Fax

Practice location:
  • Phone: 330-270-1400
  • Fax: 330-270-1404
Mailing address:
  • Phone: 330-270-1400
  • Fax: 330-270-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRX04144
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1730
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1730
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC0004537
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1730
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRX04144
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberRX04144
License Number StateOH

VIII. Authorized Official

Name: MELANIE J. GENOVA
Title or Position: CLINIC DIRECTOR
Credential: LISW-S
Phone: 330-270-1400