Provider Demographics
NPI:1992243851
Name:PONTAU, JAMES R JR (PHD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:PONTAU
Suffix:JR
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 1:9826 E. WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-5486
Mailing Address - Country:US
Mailing Address - Phone:440-708-0188
Mailing Address - Fax:440-708-0368
Practice Address - Street 1:9826 E. WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-5486
Practice Address - Country:US
Practice Address - Phone:440-708-0188
Practice Address - Fax:440-708-0368
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7533103G00000X, 103TF0200X, 103TH0004X, 103TR0400X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation