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General NPI Number Information
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NPI Number | 1982128674
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC ASSOCIATES
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 6960 MARKET ST STE 2
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City | BOARDMAN
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State | OH
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Zip | 44512-4508
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Country | US
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Telephone | 330-501-7821
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Fax | 330-953-3302
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Provider Business Mailing Address
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Address Line | 6960 MARKET ST STE 2
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City | BOARDMAN
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State | OH
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Zip | 44512-4508
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Country | US
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Telephone | 330-501-7821
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE ANN CARUSO
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Credential | LISW-S
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Telephone | 330-501-7821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E.0600050-SUPV
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1500779-SUPV
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License Number State | OH
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