Healthcare Provider Details

I. General information

NPI: 1316059686
Provider Name (Legal Business Name): PAUL YAVORNITZKY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29133 HEALTH CAMPUS DR
WESTLAKE OH
44145-5256
US

IV. Provider business mailing address

29133 HEALTH CAMPUS DR BUILDING #4
WESTLAKE OH
44145-5256
US

V. Phone/Fax

Practice location:
  • Phone: 440-835-6212
  • Fax: 440-835-6231
Mailing address:
  • Phone: 440-835-6212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5364
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: