Provider Demographics
NPI:1457508046
Name:JANOTTA, CAROL MICHALAK (PHD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MICHALAK
Last Name:JANOTTA
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 1:8221 BRECKSVILLE RD.
Mailing Address - Street 2:SUITE #101
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141
Mailing Address - Country:US
Mailing Address - Phone:216-342-4140
Mailing Address - Fax:440-792-4645
Practice Address - Street 1:8221 BRECKSVILLE RD.
Practice Address - Street 2:SUITE #101
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141
Practice Address - Country:US
Practice Address - Phone:216-342-4140
Practice Address - Fax:440-792-4645
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6468103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical