Provider Demographics
NPI:1679975585
Name:LUX, JANEL LYNN (ED S, SP00636)
Entity Type:Individual
Prefix:MRS
First Name:JANEL
Middle Name:LYNN
Last Name:LUX
Suffix:
Gender:F
Credentials:ED S, SP00636
Other - Prefix:MISS
Other - First Name:JANEL
Other - Middle Name:LYNN
Other - Last Name:CALDERONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2857 RIVIERA DR STE 203A
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3469
Mailing Address - Country:US
Mailing Address - Phone:234-901-6731
Mailing Address - Fax:
Practice Address - Street 1:2857 RIVIERA DR STE 203A
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3469
Practice Address - Country:US
Practice Address - Phone:234-901-6731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3113969103TS0200X
OHSP.00636103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool