Provider Demographics
NPI:1144523945
Name:GORTMAKER, VALERIE (PHD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:GORTMAKER
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 1:4043 RIVEREDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5629
Mailing Address - Country:US
Mailing Address - Phone:402-470-7577
Mailing Address - Fax:216-696-5768
Practice Address - Street 1:2525 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3202
Practice Address - Country:US
Practice Address - Phone:216-696-5800
Practice Address - Fax:216-696-5768
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6677103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist