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General NPI Number Information
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NPI Number | 1992045108
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Entity Type | Organization
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Legal Business Name | PSYCHIATRY NETWORKS INC
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 03/21/2019
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Provider Practice Location Address
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Address Line | 5158 BROADWAY AVE
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City | CLEVELAND
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State | OH
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Zip | 44127
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Country | US
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Telephone | 216-341-0070
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Fax | 216-341-0099
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Provider Business Mailing Address
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Address Line | 5158 BROADWAY AVE
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City | CLEVELAND
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State | OH
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Zip | 44127-1592
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Country | US
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Telephone | 216-341-0070
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Fax | 216-341-0099
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID J LOPEZ
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Credential | MD
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Telephone | 701-478-6700
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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 | 10292
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License Number State | ND
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