Provider Demographics
NPI:1720156771
Name:JANCEK, MICHAELA V (MED, LPC)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:V
Last Name:JANCEK
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 EAST 2ND ST
Mailing Address - Street 2:NORTHSHORE PSYCHOLOGICAL ASSOCIATES LLC
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507
Mailing Address - Country:US
Mailing Address - Phone:814-452-8213
Mailing Address - Fax:
Practice Address - Street 1:120 EAST 2ND ST
Practice Address - Street 2:NORTHSHORE PSYCHOLOGICAL ASSOCIATES LLC
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507
Practice Address - Country:US
Practice Address - Phone:814-452-8213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health