Provider Demographics
NPI:1215057781
Name:ROBITAILLE, CLAIRE ANN (PHD, PSYCHOLOGIST)
Entity type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:ANN
Last Name:ROBITAILLE
Suffix:
Gender:F
Credentials:PHD, PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6294 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9766
Mailing Address - Country:US
Mailing Address - Phone:740-587-7802
Mailing Address - Fax:740-321-1482
Practice Address - Street 1:31 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5514
Practice Address - Country:US
Practice Address - Phone:740-381-1777
Practice Address - Fax:740-687-6677
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS86811041C0700X
OH6497103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical