Provider Demographics
NPI:1578896387
Name:MELVIN PAINTER, PH.D., INC.
Entity Type:Organization
Organization Name:MELVIN PAINTER, PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-226-4610
Mailing Address - Street 1:14701 DETROIT AVE
Mailing Address - Street 2:SUITE 258
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4115
Mailing Address - Country:US
Mailing Address - Phone:216-226-4610
Mailing Address - Fax:216-226-4720
Practice Address - Street 1:14701 DETROIT AVE
Practice Address - Street 2:SUITE 258
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4115
Practice Address - Country:US
Practice Address - Phone:216-226-4610
Practice Address - Fax:216-226-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3040261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0512190Medicaid
OH0512190Medicaid