Provider Demographics
NPI:1730238916
Name:SEREDNESKY, GEORGE EDWARD (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:SEREDNESKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24306
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 E BROAD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1381
Practice Address - Country:US
Practice Address - Phone:614-294-0526
Practice Address - Fax:614-573-7441
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1434103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310874007026OtherCARE SOURCE
OH0262139OtherMOLINA
OH0262139Medicaid
OHCP07731Medicare ID - Type Unspecified