Provider Demographics
NPI:1710436415
Name:CENTER FOR REVOLUTIONARY RELATIONSHIPS LLC
Entity Type:Organization
Organization Name:CENTER FOR REVOLUTIONARY RELATIONSHIPS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LISW
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PADULA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-459-6743
Mailing Address - Street 1:3200 W. MARKET ST.
Mailing Address - Street 2:STE. 101
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3324
Mailing Address - Country:US
Mailing Address - Phone:330-459-6743
Mailing Address - Fax:330-595-8006
Practice Address - Street 1:3200 W. MARKET ST.
Practice Address - Street 2:STE. 101
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3324
Practice Address - Country:US
Practice Address - Phone:330-459-6743
Practice Address - Fax:330-595-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0005980106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871701953OtherNPI