Doctor Name: | MRS. ALISSA IANETTA |
NPI Number: | 1306260252 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYS |
License Number: | OH1416355 |
Business Practice Address: | 7221 Harmony Glen Dr Conneaut, OH - 440303198 |
Business Phone Number: | 4402242515 |
Business Fax Number: | |
Mailing Address: | 7221 Harmony Glen Dr, CONNEAUT |
State: | OH |
Postal Code: | 440303198 |
Phone Number: | 4402242515 |
Fax Number: | |
NPI Enumeration Date: | 02/13/2014 |
NPI Last Update Date: | 02/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | OH1416355 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |