Provider Demographics
NPI:1578589917
Name:JANATA, JEFFREY W (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:JANATA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-2400
Practice Address - Fax:216-844-1703
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3578103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0789204Medicaid
OH363666OtherWELLCARE MEDICAID
OHP00678111OtherMEDICARE RAILROAD
OH000000533014OtherANTHEM
OH000000224284OtherUNISON
OH4354456OtherAETNA
OH0789204Medicaid
OHJACP13771Medicare PIN
OH000000224284OtherUNISON