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General NPI Number Information
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NPI Number | 1295304723
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Entity Type | Organization
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Legal Business Name | SILVER LAKE PSYCHIATRY, LLC
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Dates
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Enumeration Date | 06/19/2021
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Last Update Date | 06/19/2021
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Provider Practice Location Address
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Address Line | 4466 DARROW RD STE 14
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City | STOW
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State | OH
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Zip | 44224-1891
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Country | US
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Telephone | 330-858-1173
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Fax | 330-967-0151
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Provider Business Mailing Address
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Address Line | 4466 DARROW RD STE 14
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City | STOW
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State | OH
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Zip | 44224-1891
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Country | US
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Telephone | 330-858-1173
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Fax | 330-967-0151
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | DR. MARNIE ALEXANDRA NEILL
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Credential | MD
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Telephone | 330-858-1173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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