NPIMap

Organization Active NPI

Marymount Behavioral Health Services

  • Clinical Social Worker
  • Independence, OH
National Provider Identifier
1710187364
Registry record updated Jul 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I-2164 Issued in OH
Legal business name
MARYMOUNT BEHAVIORAL HEALTH SERVICES
Practice address
6000 W Creek Rd
Suite 20
Independence, OH 44131-2139
Phone
(216) 986-1169
Fax
(216) 986-1016
NPI assigned
Jul 23, 2007
Last updated
Jul 23, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark Susin, LISW
Title
Director
Phone
(216) 986-1169

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
School Counselor 101YS0200X E-227 OH
Clinical Social Worker 1041C0700X I-2164 OH Primary

Addresses

Primary practice location

6000 W Creek Rd
Suite 20
Independence, OH 44131-2139

Mailing address

6000 W Creek Rd
Suite 20
Independence, OH 44131-2139
Phone (216) 986-1169

National Provider Directory

National Provider Directory
Tax ID family
Marymouth Hospital7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6000 W Creek Rd
Ste 20
Independence, OH 44131
Phone (216) 986-1169

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185148800000",
    "number": "1710187364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 W CREEK RD",
            "address_2": "SUITE 20",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312139",
            "telephone_number": "216-986-1169",
            "fax_number": "216-986-1016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 W CREEK RD",
            "address_2": "SUITE 20",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312139",
            "telephone_number": "216-986-1169",
            "fax_number": "216-986-1016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYMOUNT BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-23",
        "last_updated": "2007-07-23",
        "status": "A",
        "authorized_official_last_name": "SUSIN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "216-986-1169",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "OH",
            "license": "E-227",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I-2164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.