| Generations Behavioral Health Clinic, Llc | |
|
16 Colonial Dr Youngstown OH 44505-2137 | |
| (234) 232-7500 | |
| (234) 232-7072 |
| Full Name | Generations Behavioral Health Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 16 Colonial Dr, Youngstown, Ohio |
| Authorized Official Name and Position | Roxanne Jividen (CEO) |
| Authorized Official Contact | 2342327500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Generations Behavioral Health Clinic, Llc 196 Colonial Dr Youngstown OH 44505-2139 Ph: (234) 232-7500 | Generations Behavioral Health Clinic, Llc 16 Colonial Dr Youngstown OH 44505-2137 Ph: (234) 232-7500 |
| NPI Number | 1699300319 |
|---|---|
| Provider Enumeration Date | 03/04/2020 |
| Last Update Date | 03/23/2021 |
| Certification Date | 03/23/2021 |
| Medicare PECOS PAC ID | 5991124273 |
|---|---|
| Medicare Enrollment ID | O20201006002578 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699300319 | NPI | - | NPPES |
| 0394177 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mark J Zedar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801908009 PECOS PAC ID: 5597663005 Enrollment ID: I20031222000550 |
| Provider Name | Zinaida L Lebedeva |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427152925 PECOS PAC ID: 1254222524 Enrollment ID: I20040324000843 |
| Provider Name | Zyama S Goldman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255441267 PECOS PAC ID: 4183618432 Enrollment ID: I20040618001240 |
| Provider Name | Ellen Kaye |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205884731 PECOS PAC ID: 2668451295 Enrollment ID: I20040716001147 |
| Provider Name | Amy Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194754796 PECOS PAC ID: 0042273781 Enrollment ID: I20041104000587 |
| Provider Name | Roseline Okon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801998547 PECOS PAC ID: 4082613021 Enrollment ID: I20061220000316 |
| Provider Name | Patricia Ann Kountz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629382635 PECOS PAC ID: 1850571662 Enrollment ID: I20110211000189 |
| Provider Name | Wanda Cassavettes |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1578850459 PECOS PAC ID: 2769651561 Enrollment ID: I20110812000098 |
| Provider Name | Linda A Emmerich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659591576 PECOS PAC ID: 0648432328 Enrollment ID: I20120425000252 |
| Provider Name | Marian Mattern |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366799082 PECOS PAC ID: 9436387420 Enrollment ID: I20140121001556 |
| Provider Name | Adrian N Springfield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801237185 PECOS PAC ID: 0143507525 Enrollment ID: I20170512000941 |
| Provider Name | Yuliya Viner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982062600 PECOS PAC ID: 5890063010 Enrollment ID: I20170612003015 |
| Provider Name | Megan A Ledbetter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669964078 PECOS PAC ID: 5890043236 Enrollment ID: I20180801003135 |
| Provider Name | Shayna Glista |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679125876 PECOS PAC ID: 4981039047 Enrollment ID: I20200117000686 |
| Provider Name | Stephanie T Tamburro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659678217 PECOS PAC ID: 6901234137 Enrollment ID: I20200320002186 |
| Provider Name | Santiago Alberto Almanzar Disla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770926750 PECOS PAC ID: 4880838697 Enrollment ID: I20200619000385 |
| Provider Name | Jennifer L Murphy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871941294 PECOS PAC ID: 8123423860 Enrollment ID: I20210818004058 |
| Provider Name | Jadrian Db Watkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558032227 PECOS PAC ID: 0840685624 Enrollment ID: I20220314000811 |
| Provider Name | Colleen Bates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255015459 PECOS PAC ID: 4789044744 Enrollment ID: I20230721002643 |
| Provider Name | Raquel J Diaz-guerrero |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720371032 PECOS PAC ID: 9931417128 Enrollment ID: I20231204001781 |
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