Provider Demographics
NPI:1023352028
Name:OHIO GERIATRIC PSYCHOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:OHIO GERIATRIC PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:V
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:440-972-0454
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:GRAND RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44045-0570
Mailing Address - Country:US
Mailing Address - Phone:440-209-0561
Mailing Address - Fax:
Practice Address - Street 1:6817 KIRKWOOD DR
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4205
Practice Address - Country:US
Practice Address - Phone:440-209-0561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5034103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty