Provider Demographics
NPI:1063827491
Name:CONNEAUT PSYCHIATRIC SERVICES, LLC
Entity Type:Organization
Organization Name:CONNEAUT PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:440-228-0506
Mailing Address - Street 1:177 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2153
Mailing Address - Country:US
Mailing Address - Phone:440-228-0506
Mailing Address - Fax:440-593-5799
Practice Address - Street 1:177 WEST ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2153
Practice Address - Country:US
Practice Address - Phone:440-228-0506
Practice Address - Fax:440-593-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty