Provider Demographics
NPI:1396286191
Name:DEBALZO ELGUDIN LEVINE RISEN LLC
Entity type:Organization
Organization Name:DEBALZO ELGUDIN LEVINE RISEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELGUDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-831-2900
Mailing Address - Street 1:23425 COMMERCE PARK
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5844
Mailing Address - Country:US
Mailing Address - Phone:216-831-2900
Mailing Address - Fax:216-831-4306
Practice Address - Street 1:23425 COMMERCE PARK
Practice Address - Street 2:SUITE 104
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5844
Practice Address - Country:US
Practice Address - Phone:216-831-2900
Practice Address - Fax:216-831-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty