Healthcare Provider Details

I. General information

NPI: 1679545479
Provider Name (Legal Business Name): THE CENTER FOR INDEPENDENCELLC BEHAVIORAL HEALTH AND SPORT PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E ROYALTON RD
BROADVIEW HEIGHTS OH
44147-2549
US

IV. Provider business mailing address

8137 BISHOPS CT
BROADVIEW HTS OH
44147
US

V. Phone/Fax

Practice location:
  • Phone: 216-402-8200
  • Fax:
Mailing address:
  • Phone: 216-402-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE0001871
License Number StateOH

VIII. Authorized Official

Name: DR. NANCY LYNN MUSARRA
Title or Position: OWNER
Credential: LPCC PHD
Phone: 216-402-8200