Provider Demographics
NPI:1649922527
Name:CLEVELAND PSYCHOLOGICAL TESTING , LLC
Entity type:Organization
Organization Name:CLEVELAND PSYCHOLOGICAL TESTING , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TARESCAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-714-0092
Mailing Address - Street 1:16600 W SPRAGUE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6319
Mailing Address - Country:US
Mailing Address - Phone:216-714-0092
Mailing Address - Fax:
Practice Address - Street 1:16600 W SPRAGUE RD STE 260
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-6319
Practice Address - Country:US
Practice Address - Phone:216-714-0092
Practice Address - Fax:216-714-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty