Organization
SILVER LAKE PSYCHIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARNIE ALEXANDRA NEILL MD (DIRECTOR OF CLINICAL SERVICES)
(330) 858-1173
Entity
Organization
Contact information
Practice address
4466 DARROW RD STE 14, STOW, OH 44224-1891
(330) 858-1173
(330) 967-0151
Mailing address
4466 DARROW RD STE 14, STOW, OH 44224-1891
(330) 858-1173
(330) 967-0151
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0151055
—
OH
Enumeration date
06/19/2021
Last updated
06/19/2021
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