Provider Demographics
NPI:1790196871
Name:PATEL, SAGAR (PSYS, NCSP)
Entity Type:Individual
Prefix:
First Name:SAGAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PSYS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15911 ALDERSYDE DR
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2505
Mailing Address - Country:US
Mailing Address - Phone:216-295-6215
Mailing Address - Fax:
Practice Address - Street 1:15911 ALDERSYDE DR
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-2505
Practice Address - Country:US
Practice Address - Phone:216-295-6215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3107961103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool