Healthcare Provider Details

I. General information

NPI: 1215057781
Provider Name (Legal Business Name): CLAIRE ANN ROBITAILLE PH.D, PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 W CHURCH ST
NEWARK OH
43055-5514
US

IV. Provider business mailing address

6294 LAFAYETTE RD
GRANVILLE OH
43023-9766
US

V. Phone/Fax

Practice location:
  • Phone: 740-381-1777
  • Fax: 740-687-6677
Mailing address:
  • Phone: 740-587-7802
  • Fax: 740-321-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS8681
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6497
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: