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General NPI Number Information
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NPI Number | 1750434874
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Entity Type | Organization
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Legal Business Name | SUMMIT CENTER FOR BEHAVIORAL SCIENCES, LLC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 3200 W MARKET ST SUITE 205
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City | FAIRLAWN
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State | OH
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Zip | 44333-3335
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Country | US
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Telephone | 330-836-6825
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Fax | 330-836-6742
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Provider Business Mailing Address
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Address Line | 3200 W MARKET ST SUITE 205
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City | FAIRLAWN
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State | OH
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Zip | 44333-3335
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Country | US
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Telephone | 330-836-6825
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Fax | 330-836-6742
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Authorized Official
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Title or Position | OWNER
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Name | MAHER M MANSOUR
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Credential | M.D.
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Telephone | 330-836-6825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35061917
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License Number State | OH
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