Provider Demographics
NPI:1083692446
Name:GORAN, DEBRA K (PHD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:GORAN
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 1:21730 HILLIARD BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2372
Mailing Address - Country:US
Mailing Address - Phone:440-777-6017
Mailing Address - Fax:
Practice Address - Street 1:21730 HILLIARD BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-2372
Practice Address - Country:US
Practice Address - Phone:440-356-1162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4606103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical