Provider Demographics
NPI:1497861199
Name:CULBERTSON, ANITA FORSBERG (PSYD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:FORSBERG
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 MAYFIELD RD
Mailing Address - Street 2:200
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2602
Mailing Address - Country:US
Mailing Address - Phone:216-291-4000
Mailing Address - Fax:216-291-4111
Practice Address - Street 1:5001 MAYFIELD RD
Practice Address - Street 2:200
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2602
Practice Address - Country:US
Practice Address - Phone:216-291-4000
Practice Address - Fax:216-291-4111
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6125103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00272062OtherRAILROAD MEDICARE
OH000000370900OtherANTHEM
OH2570589Medicaid
OHP00272062OtherRAILROAD MEDICARE