Healthcare Provider Details

I. General information

NPI: 1699263970
Provider Name (Legal Business Name): AMANDA POPIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13422 KINSMAN RD
CLEVELAND OH
44120-4410
US

IV. Provider business mailing address

5592 LEAR NAGLE RD
NORTH RIDGEVILLE OH
44039-2118
US

V. Phone/Fax

Practice location:
  • Phone: 216-283-4400
  • Fax: 216-283-5359
Mailing address:
  • Phone: 216-283-4400
  • Fax: 216-283-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: