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General NPI Number Information
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NPI Number | 1518335603
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE CARE OF OHIO LLC
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 28602 YESHIVA LN
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City | WICKLIFFE
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State | OH
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Zip | 44092-2729
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Country | US
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Telephone | 718-506-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 20 ROBERT PITT DR UNIT 209
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City | MONSEY
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State | NY
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Zip | 10952-3330
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Country | US
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Telephone | 845-826-0060
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOEL MEISELS
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Credential |
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Telephone | 845-826-0060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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