Provider Demographics
NPI:1881604775
Name:LEDERER, JOAN ALICE (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:ALICE
Last Name:LEDERER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6929 W 130TH ST
Mailing Address - Street 2:SUITE #503
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7895
Mailing Address - Country:US
Mailing Address - Phone:440-481-3055
Mailing Address - Fax:440-481-3222
Practice Address - Street 1:6929 W 130TH ST
Practice Address - Street 2:SUITE #503
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7895
Practice Address - Country:US
Practice Address - Phone:440-481-3055
Practice Address - Fax:440-481-3222
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2014-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH350606502084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry