Provider Demographics
NPI:1780646810
Name:COMPREHENSIVE PSYCHIATRY SPECIALISTS
Entity Type:Organization
Organization Name:COMPREHENSIVE PSYCHIATRY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LSW
Authorized Official - Phone:330-884-1913
Mailing Address - Street 1:955 WINDHAM CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5035
Mailing Address - Country:US
Mailing Address - Phone:330-884-1900
Mailing Address - Fax:330-884-1928
Practice Address - Street 1:955 WINDHAM CT
Practice Address - Street 2:SUITE 2
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5035
Practice Address - Country:US
Practice Address - Phone:330-884-1900
Practice Address - Fax:330-884-1928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0166672Medicaid