Provider Demographics
NPI:1063424497
Name:VASILAKIS, WILLIAM H (PSYD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:VASILAKIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4985 SEARLS DR NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7464
Mailing Address - Country:US
Mailing Address - Phone:330-418-0042
Mailing Address - Fax:
Practice Address - Street 1:204 S BROAD ST
Practice Address - Street 2:2210
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-7501
Practice Address - Country:US
Practice Address - Phone:740-689-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2283738Medicaid
OH2283738Medicaid
CP25703Medicare PIN
CP25703Medicare PIN