Provider Demographics
NPI:1386725349
Name:NOLL, PAMELA V (PHD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:V
Last Name:NOLL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3872 E HARBOR LIGHT LANDING DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-3877
Mailing Address - Country:US
Mailing Address - Phone:419-734-3333
Mailing Address - Fax:877-734-2030
Practice Address - Street 1:30432 EUCLID AVE
Practice Address - Street 2:SUITE 221
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-1552
Practice Address - Country:US
Practice Address - Phone:440-585-4500
Practice Address - Fax:330-499-2536
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5343103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6100374OtherEVERCARE
OH680009560OtherRAILROAD MEDICARE
OH92895OtherQUALCHOICE
OH000000137855OtherANTHEM
OH290600000OtherMAGELLAN
OH2060157Medicaid
OH2060157Medicaid