Provider Demographics
NPI:1316270119
Name:NEW BEGINNINGS EATING DISORDERS CENTER, LLC
Entity type:Organization
Organization Name:NEW BEGINNINGS EATING DISORDERS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:PICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA; PCC-S
Authorized Official - Phone:330-666-5004
Mailing Address - Street 1:3632 W MARKET ST
Mailing Address - Street 2:SUITE 104 WEST
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2494
Mailing Address - Country:US
Mailing Address - Phone:330-666-5004
Mailing Address - Fax:330-666-5001
Practice Address - Street 1:3632 W MARKET ST
Practice Address - Street 2:SUITE 104 WEST
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2494
Practice Address - Country:US
Practice Address - Phone:330-666-5004
Practice Address - Fax:330-666-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty