Healthcare Provider Details

I. General information

NPI: 1144396011
Provider Name (Legal Business Name): PSYCH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26777 LORAIN RD SUITE 716
NORTH OLMSTED OH
44070-3200
US

IV. Provider business mailing address

26777 LORAIN RD SUITE 716
NORTH OLMSTED OH
44070-3200
US

V. Phone/Fax

Practice location:
  • Phone: 440-777-9200
  • Fax: 440-777-9288
Mailing address:
  • Phone: 440-777-9200
  • Fax: 440-777-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number3637
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3637
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17264
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3637
License Number StateOH

VIII. Authorized Official

Name: DR. NANCY J DUFF-BOEHM
Title or Position: CLINICAL DIRECTOR
Credential: PH.D.
Phone: 440-777-9200