# 92ND STREET PSYCH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003614181
- **Authorized official:** BIANCA OLIVERA (PRACTICE MANAGER)
- **Authorized official phone:** (330) 294-4408

## Contact information

- **Practice address:** 72 N MAIN ST STE 207, HUDSON, OH 44236-2867
- **Practice address phone:** (330) 294-4408
- **Mailing address:** 72 N MAIN ST STE 207, HUDSON, OH 44236-2867
- **Mailing address phone:** (330) 294-4408
- **Mailing address fax:** (234) 269-5428

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/05/2025
- **Last updated:** 04/15/2026