Healthcare Provider Details
I. General information
NPI: 1508936204
Provider Name (Legal Business Name): CENTRAL OHIO BEHAVIORAL MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5151 REED RD BLDG C STE 128
COLUMBUS OH
43220-2553
US
IV. Provider business mailing address
5151 REED RD BLDG C STE 128
COLUMBUS OH
43220-2553
US
V. Phone/Fax
- Phone: 614-538-8300
- Fax: 614-538-1656
- Phone: 614-538-8300
- Fax: 614-538-1656
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
PETER
PANOS
ZAFIRIDES
Title or Position: PRESIDENT
Credential: MD
Phone: 614-538-8300