Provider Demographics
NPI:1851604193
Name:SERENITY BEHAVIORAL SCIENCE CENTER
Entity Type:Organization
Organization Name:SERENITY BEHAVIORAL SCIENCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYASREE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NANDAGOPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-847-4491
Mailing Address - Street 1:7760 UNIVERSITY CT
Mailing Address - Street 2:SUITE H
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3371
Mailing Address - Country:US
Mailing Address - Phone:513-847-4491
Mailing Address - Fax:
Practice Address - Street 1:7760 UNIVERSITY CT
Practice Address - Street 2:SUITE H
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3371
Practice Address - Country:US
Practice Address - Phone:513-847-4491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350882162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty