Healthcare Provider Details

I. General information

NPI: 1639809692
Provider Name (Legal Business Name): CUYAHOGA VALLEY PSYCHOLOGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4833 DARROW RD STE 100
STOW OH
44224-1411
US

IV. Provider business mailing address

4833 DARROW RD STE 100
STOW OH
44224-1411
US

V. Phone/Fax

Practice location:
  • Phone: 330-422-3255
  • Fax: 330-422-3256
Mailing address:
  • Phone: 330-422-3255
  • Fax: 330-422-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DIANE MORAN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 330-422-3255