Provider Demographics
NPI:1972380269
Name:EMERALD PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:EMERALD PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAJCNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-908-4636
Mailing Address - Street 1:76 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1133
Mailing Address - Country:US
Mailing Address - Phone:614-908-4636
Mailing Address - Fax:614-407-9540
Practice Address - Street 1:76 S HIGH ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1133
Practice Address - Country:US
Practice Address - Phone:614-908-4636
Practice Address - Fax:614-407-9540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty