Provider Demographics
NPI:1063037331
Name:PARK-SALTZMAN PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:PARK-SALTZMAN PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEESEON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK-SALTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:614-929-5170
Mailing Address - Street 1:4929 DIERKER RD STE A
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2946
Mailing Address - Country:US
Mailing Address - Phone:614-563-5940
Mailing Address - Fax:
Practice Address - Street 1:4929 DIERKER RD STE A
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43220-2946
Practice Address - Country:US
Practice Address - Phone:614-929-5170
Practice Address - Fax:614-929-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)