Provider Demographics
NPI:1477660231
Name:LOVINGER, MARK (PHD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LOVINGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23811 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5525
Mailing Address - Country:US
Mailing Address - Phone:216-464-1277
Mailing Address - Fax:216-464-9109
Practice Address - Street 1:23811 CHAGRIN BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5525
Practice Address - Country:US
Practice Address - Phone:216-464-1277
Practice Address - Fax:216-464-9109
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3869103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000234656OtherANTHEM
OH0666186Medicaid
OHLOCP03032Medicare ID - Type Unspecified