Provider Demographics
NPI:1053711135
Name:KORTANEK PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:KORTANEK PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KORTANEK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:216-245-6231
Mailing Address - Street 1:24800 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24800 CHAGRIN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5648
Practice Address - Country:US
Practice Address - Phone:216-245-6231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6995103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty