| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 06/19/2021 |
| Last Update Date | 06/19/2021 |
| Certification Date | 06/19/2021 |
| Medicare PECOS PAC ID | 2860833605 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467893339 PECOS PAC ID: 2466700927 Enrollment ID: I20180731003953 |
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