Healthcare Provider Details

I. General information

NPI: 1548280290
Provider Name (Legal Business Name): JA'NITTA MARBURY PH.D., PCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5589 DUNHAM RD
MAPLE HEIGHTS OH
44137-3657
US

IV. Provider business mailing address

5589 DUNHAM RD
MAPLE HEIGHTS OH
44137-3657
US

V. Phone/Fax

Practice location:
  • Phone: 216-371-3420
  • Fax: 216-371-3430
Mailing address:
  • Phone: 216-371-3420
  • Fax: 216-371-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0500062-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: