Healthcare Provider Details

I. General information

NPI: 1902734361
Provider Name (Legal Business Name): MARYJO DIGIANDOMENICO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3557 PERRY CT
LORAIN OH
44053-1191
US

IV. Provider business mailing address

3557 PERRY CT
LORAIN OH
44053-1191
US

V. Phone/Fax

Practice location:
  • Phone: 440-610-1195
  • Fax: 440-366-4643
Mailing address:
  • Phone: 440-366-7351
  • Fax: 440-366-4643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: