Healthcare Provider Details

I. General information

NPI: 1982128674
Provider Name (Legal Business Name): THERAPEUTIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6960 MARKET ST STE 2
BOARDMAN OH
44512-4508
US

IV. Provider business mailing address

6960 MARKET ST STE 2
BOARDMAN OH
44512-4508
US

V. Phone/Fax

Practice location:
  • Phone: 330-501-7821
  • Fax: 330-953-3302
Mailing address:
  • Phone: 330-501-7821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0600050-SUPV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1500779-SUPV
License Number StateOH

VIII. Authorized Official

Name: STEPHANIE ANN CARUSO
Title or Position: OWNER
Credential: LISW-S
Phone: 330-501-7821