Healthcare Provider Details

I. General information

NPI: 1497028005
Provider Name (Legal Business Name): PSI ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 CASE PARKWAY SOUTH #10
TWINSBURG OH
44087
US

IV. Provider business mailing address

PO BOX 468 2112 CASE PARKWAY SOUTH #10
TWINSBURG OH
44087
US

V. Phone/Fax

Practice location:
  • Phone: 330-425-8474
  • Fax: 330-425-2905
Mailing address:
  • Phone: 330-425-8474
  • Fax: 330-425-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2952
License Number StateOH

VIII. Authorized Official

Name: STEVEN L ROSENBERG
Title or Position: PRESIDENT
Credential: PHD
Phone: 330-425-8474