Healthcare Provider Details

I. General information

NPI: 1033219225
Provider Name (Legal Business Name): NORTH COAST MENTAL HEALTH ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 ORANGE PL 430
BEACHWOOD OH
44122-4464
US

IV. Provider business mailing address

3690 ORANGE PL 430
BEACHWOOD OH
44122-4464
US

V. Phone/Fax

Practice location:
  • Phone: 216-464-5330
  • Fax:
Mailing address:
  • Phone: 216-464-5330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CAREN WISHNEK
Title or Position: PRACTICE MANAGER
Credential:
Phone: 216-464-5330