Provider Demographics
NPI:1114976701
Name:SUMMIT PSYCHOLOGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SUMMIT PSYCHOLOGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-535-8181
Mailing Address - Street 1:37 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1910
Mailing Address - Country:US
Mailing Address - Phone:330-535-8181
Mailing Address - Fax:330-535-9336
Practice Address - Street 1:37 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1910
Practice Address - Country:US
Practice Address - Phone:330-535-8181
Practice Address - Fax:330-535-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0529103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9237741Medicare PIN
OH9237742Medicare PIN
OH9237745Medicare PIN