Provider Demographics
NPI:1629240502
Name:DAMANKOS, FREDERICK JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JOHN
Last Name:DAMANKOS
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 1:2346 DEMINGTON DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3618
Mailing Address - Country:US
Mailing Address - Phone:216-932-2988
Mailing Address - Fax:216-932-2988
Practice Address - Street 1:2346 DEMINGTON DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3618
Practice Address - Country:US
Practice Address - Phone:216-932-2988
Practice Address - Fax:216-932-2988
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0258680Medicaid
OHCP22051Medicare PIN