Healthcare Provider Details

I. General information

NPI: 1588864250
Provider Name (Legal Business Name): LINDA Y. DAKWAR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 CHILLICOTHE RD
KIRTLAND OH
44094-9734
US

IV. Provider business mailing address

10001 CHILLICOTHE RD
KIRTLAND OH
44094-9734
US

V. Phone/Fax

Practice location:
  • Phone: 440-256-1001
  • Fax:
Mailing address:
  • Phone: 440-256-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5542
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number5542
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number5542
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5542
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number5542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: