Provider Demographics
NPI:1669008249
Name:WALTMAN PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:WALTMAN PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LICDC-CS
Authorized Official - Phone:216-766-5730
Mailing Address - Street 1:3401 ENTERPRISE PKWY STE 340
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7340
Mailing Address - Country:US
Mailing Address - Phone:216-766-5730
Mailing Address - Fax:216-766-5796
Practice Address - Street 1:3401 ENTERPRISE PKWY STE 340
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7340
Practice Address - Country:US
Practice Address - Phone:216-766-5730
Practice Address - Fax:216-766-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0615650Medicaid