Provider Demographics
NPI:1801124730
Name:EACOTT, DENISE ANN (PHD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:EACOTT
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 1:7575 LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2701
Mailing Address - Country:US
Mailing Address - Phone:440-773-3032
Mailing Address - Fax:
Practice Address - Street 1:7575 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-2701
Practice Address - Country:US
Practice Address - Phone:440-773-3032
Practice Address - Fax:440-984-7027
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6607103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical