Provider Demographics
NPI:1780043554
Name:JANCO- GIDLEY, JULIE ANNE (PHD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:JANCO- GIDLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:JANCO-GIDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:25101 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-273-8127
Mailing Address - Fax:440-260-8305
Practice Address - Street 1:25101 CHAGRIN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-273-8127
Practice Address - Fax:440-260-8576
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6637103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling