Provider Demographics
NPI:1407427321
Name:WEST VIRGINIA PSYCH. SERVICES PLLC
Entity Type:Organization
Organization Name:WEST VIRGINIA PSYCH. SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-536-3746
Mailing Address - Street 1:3593 MEDINA RD # 181
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8182
Mailing Address - Country:US
Mailing Address - Phone:330-536-3746
Mailing Address - Fax:330-267-4250
Practice Address - Street 1:47 WASHINGTON AVE # 168
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6240
Practice Address - Country:US
Practice Address - Phone:330-536-3746
Practice Address - Fax:330-267-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty