Provider Demographics
NPI:1417936592
Name:JAMES W SIDDALL PHD AND ASSOCIATES
Entity Type:Organization
Organization Name:JAMES W SIDDALL PHD AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WARNER
Authorized Official - Last Name:SIDDALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-825-5734
Mailing Address - Street 1:4057 CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-5638
Mailing Address - Country:US
Mailing Address - Phone:330-825-5734
Mailing Address - Fax:330-825-5151
Practice Address - Street 1:4057 CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-5638
Practice Address - Country:US
Practice Address - Phone:330-825-5734
Practice Address - Fax:330-825-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2002103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP00911Medicare ID - Type Unspecified