Provider Demographics
NPI:1396763231
Name:JASSANI, AMIR (PHD)
Entity type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:JASSANI
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 1:12300 MCCRACKEN RD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2914
Mailing Address - Country:US
Mailing Address - Phone:216-587-8350
Mailing Address - Fax:216-587-8646
Practice Address - Street 1:12300 MCCRACKEN RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2914
Practice Address - Country:US
Practice Address - Phone:216-587-8350
Practice Address - Fax:216-587-8646
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4756103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000216093OtherANTHEM PIN
OH351618OtherWELLCARE HEALTH PLAN
OHT04756OtherSUMMACARE HEALTH PLAN
OH000000216093OtherUNICARE
OH2626180Medicaid
OH7705135OtherAETNA
OH740995OtherBUCKEYE HEALTH PLAN
OH740995OtherBUCKEYE HEALTH PLAN
OH351618OtherWELLCARE HEALTH PLAN