| 92nd Street Psych Llc | |
|
72 N Main St Ste 207 Hudson OH 44236-2867 | |
| (330) 294-4408 | |
| Not Available |
| Full Name | 92nd Street Psych Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 72 N Main St Ste 207, Hudson, Ohio |
| Authorized Official Name and Position | Bianca Olivera (CREDENTIALING) |
| Authorized Official Contact | 3302944408 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 92nd Street Psych Llc 72 N Main St Ste 207 Hudson OH 44236-2867 Ph: (330) 294-4408 | 92nd Street Psych Llc 72 N Main St Ste 207 Hudson OH 44236-2867 Ph: (330) 294-4408 |
| NPI Number | 1003614181 |
|---|---|
| Provider Enumeration Date | 03/05/2025 |
| Last Update Date | 11/25/2025 |
| Medicare PECOS PAC ID | 3971021460 |
|---|---|
| Medicare Enrollment ID | O20250519001694 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003614181 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Elizabeth H Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356636914 PECOS PAC ID: 6901038371 Enrollment ID: I20140417001001 |
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