Provider Demographics
NPI:1477976652
Name:WILLETT, CAROLINE PEJEAU (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:PEJEAU
Last Name:WILLETT
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 1:2984 CLEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3096
Mailing Address - Country:US
Mailing Address - Phone:330-920-1443
Mailing Address - Fax:330-920-1443
Practice Address - Street 1:2984 CLEAR CREEK DR
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3096
Practice Address - Country:US
Practice Address - Phone:330-920-1443
Practice Address - Fax:330-920-1443
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5566103T00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral