MEDICARE: DR. JA'NITTA MARBURY PH.D., PCC-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	E0500062-SUPV	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2598130	OTHER	UNITED HEALTHCARE
3	7931741	OTHER	AETNA
4	000000329113	OTHER	BCBS
5	1000694	OTHER	QUALCHOICE
6	724645000	OTHER	MAGELLAN

General Provider Information

NPI Number	:	1548280290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JA'NITTA MARBURY PH.D., PCC-S

Provider Business Mailing Address
First Line	:	5589 DUNHAM RD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3657
Country	:	US
Telephone Number	:	216-371-3420
Fax Number	:	216-371-3430

Provider Business Practice Location Address
First Line	:	5589 DUNHAM RD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3657
Country	:	US
Telephone Number	:	216-371-3420
Fax Number	:	216-371-3430

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	02/03/2023

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Directions to “ DR. JA'NITTA MARBURY PH.D., PCC-S” Practice Location

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