Active NPI
Pamela V Noll, PHD
- Clinical Psychologist
- Wickliffe, OH
National Provider Identifier
1386725349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 5343
- Practice address
- 30432 Euclid Ave
Suite 221
Wickliffe, OH 44092-1552 - Phone
- (440) 585-4500
- Fax
- (330) 499-2536
- NPI assigned
- Oct 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 5343 | OH | Primary |
Addresses
Primary practice location
30432 Euclid Ave
Suite 221
Wickliffe, OH 44092-1552
Mailing address
3872 E Harbor Light Landing Dr
Suite 221
Port Clinton, OH 43452-3877
Phone (419) 734-3333
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6100374 | Other | OH | EVERCARE |
| 680009560 | Other | OH | RAILROAD MEDICARE |
| 92895 | Other | OH | QUALCHOICE |
| 000000137855 | Other | OH | ANTHEM |
| 290600000 | Other | OH | MAGELLAN |
| 2060157 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5343 | OH | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475107200000",
"number": "1386725349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3872 E HARBOR LIGHT LANDING DR",
"address_2": "SUITE 221",
"city": "PORT CLINTON",
"state": "OH",
"postal_code": "434523877",
"telephone_number": "419-734-3333",
"fax_number": "877-734-2030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30432 EUCLID AVE",
"address_2": "SUITE 221",
"city": "WICKLIFFE",
"state": "OH",
"postal_code": "440921552",
"telephone_number": "440-585-4500",
"fax_number": "330-499-2536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOLL",
"first_name": "PAMELA",
"middle_name": "V",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-18",
"last_updated": "2016-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "5343",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERCARE",
"identifier": "6100374",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "680009560",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUALCHOICE",
"identifier": "92895",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000137855",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "290600000",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2060157",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wickliffe, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.