Provider Demographics
NPI:1518098334
Name:PSYCARE INC
Entity Type:Organization
Organization Name:PSYCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GENOVA
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:330-270-1400
Mailing Address - Street 1:136 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515
Mailing Address - Country:US
Mailing Address - Phone:330-270-1400
Mailing Address - Fax:330-270-1404
Practice Address - Street 1:136 WESTCHESTER DRIVE
Practice Address - Street 2:SUITE 5
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515
Practice Address - Country:US
Practice Address - Phone:330-270-1400
Practice Address - Fax:330-270-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1730101YM0800X, 103T00000X, 106H00000X
OHRX04144103TP0016X, 163WP0808X, 363LP0808X
OHC0004537104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9219957Medicare PIN