Silver Lake Psychiatry, Llc | |
4466 Darrow Rd Ste 14 Stow OH 44224-1891 | |
(330) 858-1173 | |
(330) 967-0151 |
Full Name | Silver Lake Psychiatry, Llc |
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Speciality | Psychiatry & Neurology |
Location | 4466 Darrow Rd Ste 14, Stow, Ohio |
Authorized Official Name and Position | Marnie Alexandra Neill (DIRECTOR OF CLINICAL SERVICES) |
Authorized Official Contact | 3308581173 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Silver Lake Psychiatry, Llc 4466 Darrow Rd Ste 14 Stow OH 44224-1891 Ph: (330) 858-1173 | Silver Lake Psychiatry, Llc 4466 Darrow Rd Ste 14 Stow OH 44224-1891 Ph: (330) 858-1173 |
NPI Number | 1295304723 |
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Provider Enumeration Date | 06/19/2021 |
Last Update Date | 06/19/2021 |
Certification Date | 06/19/2021 |
Medicare PECOS PAC ID | 2860833605 |
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Medicare Enrollment ID | O20240510003027 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295304723 | NPI | - | NPPES |
0151055 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101Y00000X | Counselor | (* (Not Available)) | Secondary |
2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
Provider Name | Ryan Rajaram |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1467893339 PECOS PAC ID: 2466700927 Enrollment ID: I20180731003953 |
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