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General NPI Number Information
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NPI Number | 1639809692
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Entity Type | Organization
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Legal Business Name | CUYAHOGA VALLEY PSYCHOLOGICAL LLC
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 4833 DARROW RD STE 100
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City | STOW
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State | OH
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Zip | 44224-1411
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Country | US
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Telephone | 330-422-3255
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Fax | 330-422-3256
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Provider Business Mailing Address
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Address Line | 4833 DARROW RD STE 100
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City | STOW
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State | OH
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Zip | 44224-1411
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Country | US
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Telephone | 330-422-3255
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Fax | 330-422-3256
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIANE MORAN
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Credential | PH.D.
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Telephone | 330-422-3255
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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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