Provider Demographics
NPI:1316059686
Name:YAVORNITZKY, PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:YAVORNITZKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29133 HEALTH CAMPUS DR
Mailing Address - Street 2:BUILDING #4
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5256
Mailing Address - Country:US
Mailing Address - Phone:440-835-6212
Mailing Address - Fax:
Practice Address - Street 1:29133 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5256
Practice Address - Country:US
Practice Address - Phone:440-835-6212
Practice Address - Fax:440-835-6231
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5364103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0308483Medicaid
OHYACP24922Medicare ID - Type UnspecifiedMEDICARE NUMBER
OHYACP24921Medicare ID - Type UnspecifiedMEDICARE NUMBER
OH0308483Medicaid