Provider Demographics
NPI:1891807632
Name:REDLE PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:REDLE PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:REDLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-926-0760
Mailing Address - Street 1:2321 2ND STREET
Mailing Address - Street 2:SUITE 118
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221
Mailing Address - Country:US
Mailing Address - Phone:330-926-0760
Mailing Address - Fax:330-926-1944
Practice Address - Street 1:2321 2ND STREET
Practice Address - Street 2:SUITE 118
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221
Practice Address - Country:US
Practice Address - Phone:330-926-0760
Practice Address - Fax:330-926-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5555103TC0700X
OH5989103TC0700X
OH5934103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE9351331Medicare ID - Type Unspecified
Y28999Medicare UPIN