Provider Demographics
NPI:1962913574
Name:MASSIMO, JULIANNE SKROVAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JULIANNE
Middle Name:SKROVAN
Last Name:MASSIMO
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 1:4938 GLENRIDGE CIR NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-1135
Mailing Address - Country:US
Mailing Address - Phone:440-213-2906
Mailing Address - Fax:
Practice Address - Street 1:37 N BROADWAY ST STE 200
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1910
Practice Address - Country:US
Practice Address - Phone:330-535-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
OHE.2102094101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling