Provider Demographics
NPI:1619276409
Name:PEACE & RESILIENCE PARENTING PROGRAM, INC.
Entity Type:Organization
Organization Name:PEACE & RESILIENCE PARENTING PROGRAM, INC.
Other - Org Name:PEACE AND RESILIENCE PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MOIRA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L,MHS
Authorized Official - Phone:3309-429-8001
Mailing Address - Street 1:1755 W MARKET ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7040
Mailing Address - Country:US
Mailing Address - Phone:234-738-5560
Mailing Address - Fax:330-319-7757
Practice Address - Street 1:1755 W MARKET ST
Practice Address - Street 2:SUITE D
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7040
Practice Address - Country:US
Practice Address - Phone:234-738-5560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-20
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-003356251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health