UPI (Provider ID): 10129
Change Report (if Any):

Short Name: NE OH PSY-MAHO

Long Name 1: NORTHEAST OHIO PSYCHOLOGICAL
Long Name 2:

Address 1: 1285 BOARDMAN CANFIELD ROAD
Address 2:

City: YOUNGSTOWN
Zip Code: 44512
County: MAHO

Contact: BETH BECKWITH
Title: FIN
Phone: 3307580059
FAX: 3307586496

Vendor: 10034

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016