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General NPI Number Information
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NPI Number | 1053711135
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Entity Type | Organization
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Legal Business Name | KORTANEK PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 24800 CHAGRIN BLVD SUITE 103
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City | BEACHWOOD
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State | OH
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Zip | 44122-5648
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Country | US
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Telephone | 216-245-6231
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Fax |
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Provider Business Mailing Address
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Address Line | 24800 CHAGRIN BLVD SUITE 103
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City | BEACHWOOD
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State | OH
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Zip | 44122-5648
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC MATTHEW KORTANEK
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Credential | PSY.D.
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Telephone | 216-245-6231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6995
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License Number State | OH
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