Provider Demographics
NPI:1144612300
Name:CORNERSTONE PSYCHOLOGICAL & COUNSELING SERVICES OF NORTHEAST OHIO
Entity Type:Organization
Organization Name:CORNERSTONE PSYCHOLOGICAL & COUNSELING SERVICES OF NORTHEAST OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-336-2800
Mailing Address - Street 1:195 WADSWORTH RD STE 201A
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9504
Mailing Address - Country:US
Mailing Address - Phone:330-336-2800
Mailing Address - Fax:
Practice Address - Street 1:4018 MEDINA RD STE D
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9675
Practice Address - Country:US
Practice Address - Phone:330-722-4166
Practice Address - Fax:330-336-5325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0126029Medicaid