| Stella Maris | |
|
1302 Winslow Ave Cleveland OH 44113-2336 | |
| (216) 781-0550 | |
| (216) 781-7501 |
| Full Name | Stella Maris |
|---|---|
| Speciality | Clinic/Center |
| Location | 1302 Winslow Ave, Cleveland, Ohio |
| Authorized Official Name and Position | Deborah A. Bridwell (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2167272058 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stella Maris 1320 Washington Ave Cleveland OH 44113-2333 Ph: (216) 781-0550 | Stella Maris 1302 Winslow Ave Cleveland OH 44113-2336 Ph: (216) 781-0550 |
| NPI Number | 1487927802 |
|---|---|
| Provider Enumeration Date | 02/15/2012 |
| Last Update Date | 05/16/2017 |
| Medicare PECOS PAC ID | 6800165077 |
|---|---|
| Medicare Enrollment ID | O20171108001967 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487927802 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 0679 (Ohio) | Primary |
| Provider Name | Joseph F Lydon |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1598766859 PECOS PAC ID: 5698663888 Enrollment ID: I20151223000345 |
| Provider Name | Rich Maxey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730536350 PECOS PAC ID: 8426315821 Enrollment ID: I20171120000829 |
| Provider Name | Megan Nicole Kyea |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851856017 PECOS PAC ID: 3173855038 Enrollment ID: I20191024003152 |
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