Provider Demographics
NPI:1457824278
Name:CENTER FOR NEURODIVERSITY & SUCCESS LLC
Entity Type:Organization
Organization Name:CENTER FOR NEURODIVERSITY & SUCCESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATAK-PIETRAFESA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW-LISW-S
Authorized Official - Phone:614-450-2155
Mailing Address - Street 1:300 E KANAWHA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1212
Mailing Address - Country:US
Mailing Address - Phone:614-450-2155
Mailing Address - Fax:614-675-2216
Practice Address - Street 1:3840 N HIGH ST STE D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3761
Practice Address - Country:US
Practice Address - Phone:614-450-2155
Practice Address - Fax:614-675-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty