Healthcare Provider Details

I. General information

NPI: 1831204791
Provider Name (Legal Business Name): ADVANCED THERAPY CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 AUBURN DR SUITE 200
BEACHWOOD OH
44122
US

IV. Provider business mailing address

2000 AUBURN DR SUITE 200
BEACHWOOD OH
44122-4314
US

V. Phone/Fax

Practice location:
  • Phone: 216-378-7633
  • Fax: 216-378-7634
Mailing address:
  • Phone: 216-378-7633
  • Fax: 216-378-7634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK LOVINGER
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 216-464-1277