Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 83876 | OH |
Y | 102L00000X | Psychologist | C1743 | OH |
Y | 103T00000X | Psychologist | C1743 | OH |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 601231 | OH |
NPI | 1538312541 |
---|---|
Provider Name | Mr. John J. Rehak JR. |
First Address | Rocky River, OH 44116-3901 |
Second Address | Rocky River, OH 44116-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2008 |
Last Update Date | 04/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0208475 | (05) | OH |