MEDICARE: FREDERICK JOHN DAMANKOS PH.D.

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	103TC0700X	Clinical Psychologist	1126	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629240502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK JOHN DAMANKOS PH.D.

Provider Business Mailing Address
First Line	:	2346 DEMINGTON DR
Second Line	:	SUITE 2
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3618
Country	:	US
Telephone Number	:	216-932-2988
Fax Number	:	216-932-2988

Provider Business Practice Location Address
First Line	:	2346 DEMINGTON DR
Second Line	:	SUITE 2
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3618
Country	:	US
Telephone Number	:	216-932-2988
Fax Number	:	216-932-2988

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

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	03/31/2008

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