Provider Demographics
NPI:1568948651
Name:FORENSIC PSYCHOLOGICAL CENTER OF NORTHEAST OHIO
Entity Type:Organization
Organization Name:FORENSIC PSYCHOLOGICAL CENTER OF NORTHEAST OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:RINDSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, ABPP
Authorized Official - Phone:216-245-6311
Mailing Address - Street 1:25200 CHAGRIN BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5681
Mailing Address - Country:US
Mailing Address - Phone:216-245-6311
Mailing Address - Fax:888-567-7553
Practice Address - Street 1:25200 CHAGRIN BLVD STE 105
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5681
Practice Address - Country:US
Practice Address - Phone:216-245-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5982103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty