Provider Demographics
NPI:1033268883
Name:PETRONE, MARGARET MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARIE
Last Name:PETRONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15711 MADISON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5655
Mailing Address - Country:US
Mailing Address - Phone:216-221-0600
Mailing Address - Fax:216-221-3865
Practice Address - Street 1:15711 MADISON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5655
Practice Address - Country:US
Practice Address - Phone:216-221-0600
Practice Address - Fax:216-221-3865
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5775103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist