Provider Demographics
NPI:1073004131
Name:LAKEWEST DBT CENTER LLC
Entity Type:Organization
Organization Name:LAKEWEST DBT CENTER LLC
Other - Org Name:TABONO CENTER FOR WELLBEING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBIERALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:216-787-5898
Mailing Address - Street 1:15711 MADISON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5655
Mailing Address - Country:US
Mailing Address - Phone:216-787-5898
Mailing Address - Fax:
Practice Address - Street 1:15711 MADISON AVE STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5655
Practice Address - Country:US
Practice Address - Phone:216-787-5898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TABONO CENTER FOR WELLBEING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7261261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1073866158Medicaid