Organization
LICKING MEMORIAL PROFESSIONAL CORPORATION
Active
Other names
Licking Memorial Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT A. MONTAGNESE (EXECUTIVE VICE PRESIDENT)
(740) 348-4000
Entity
Organization
Contact information
Practice address
200 MESSIMER DR, NEWARK, OH 43055-3627
(740) 348-4870
(740) 348-4871
Mailing address
200 MESSIMER DR, NEWARK, OH 43055-3627
(740) 348-4870
(740) 348-4871
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0118992
—
OH
Enumeration date
06/07/2006
Last updated
08/22/2020
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