Provider Demographics
NPI:1326769829
Name:MANRODT PSYCHIATRY, LLC.
Entity Type:Organization
Organization Name:MANRODT PSYCHIATRY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MANRODT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:440-381-8237
Mailing Address - Street 1:25 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6975
Mailing Address - Country:US
Mailing Address - Phone:440-381-8237
Mailing Address - Fax:440-306-3584
Practice Address - Street 1:25 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6975
Practice Address - Country:US
Practice Address - Phone:440-381-8237
Practice Address - Fax:440-306-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty