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Organization
PSYCHIATRIC AND PSYCHOLOGICAL SERVICE
Active
Organization
PSYCHIATRIC AND PSYCHOLOGICAL SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA SANTANTONIO ED.S. (CO-OWNER)
(440) 323-5121
Entity
Organization
Contact information
Practice address
750 S ABBE RD, ELYRIA, OH 44035-7246
(440) 323-5121
(440) 323-5134
Mailing address
750 S ABBE RD, ELYRIA, OH 44035-7246
(440) 323-5121
(440) 323-5134
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
07116
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000157251
ANTHEM BLUE CROSS PIN
OH
01
—
104917
KAISER PIN
OH
01
—
701291000
MAGELLAN MIS NUMBER
OH
Enumeration date
05/29/2006
Last updated
02/15/2012
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