Provider Demographics
NPI:1528102654
Name:RIVERSIDE COUNSELING ASSOCIATES, INC.
Entity type:Organization
Organization Name:RIVERSIDE COUNSELING ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASSADY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PSYCHOLOGIST
Authorized Official - Phone:440-992-7878
Mailing Address - Street 1:4510 COLLINS BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6954
Mailing Address - Country:US
Mailing Address - Phone:440-992-7878
Mailing Address - Fax:440-992-7887
Practice Address - Street 1:4510 COLLINS BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6954
Practice Address - Country:US
Practice Address - Phone:440-992-7878
Practice Address - Fax:440-992-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00023031041C0700X
OHE2512101YP2500X
OHE3468101YP2500X
OHE4265101YP2500X
OHI2171041C0700X
OHI91691041C0700X
OH34-00-1718-M208D00000X
OH3565103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0022880Medicaid
OH9344011Medicare PIN