Healthcare Provider Details

I. General information

NPI: 1518335603
Provider Name (Legal Business Name): SUPPORTIVE CARE OF OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28602 YESHIVA LN
WICKLIFFE OH
44092-2729
US

IV. Provider business mailing address

20 ROBERT PITT DR UNIT 209
MONSEY NY
10952-3330
US

V. Phone/Fax

Practice location:
  • Phone: 718-506-1115
  • Fax:
Mailing address:
  • Phone: 845-826-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOEL MEISELS
Title or Position: PRESIDENT
Credential:
Phone: 845-826-0060