Active NPI
Jacqueline Jolly
- Psychologist
- Shaker Heights, OH
National Provider Identifier
1942317185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 5838
- Practice address
- 3642 Avalon Rd
Shaker Heights, OH 44120-5207 - Phone
- (216) 561-0190
- Fax
- (216) 321-3408
- NPI assigned
- Aug 24, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 5838 | OH | Primary |
| Psychologist | 103T00000X | 18845 | CA |
Addresses
Primary practice location
3642 Avalon Rd
Shaker Heights, OH 44120-5207
Mailing address
2628 Euclid Heights Blvd
Cleveland Heights, OH 44106-2811
Phone (216) 321-3408
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18845 | CA | MD | Psychologist |
| 5838 | OH | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942317185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2628 EUCLID HEIGHTS BLVD",
"city": "CLEVELAND HEIGHTS",
"state": "OH",
"postal_code": "441062811",
"telephone_number": "216-321-3408",
"fax_number": "216-321-3408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3642 AVALON RD",
"city": "SHAKER HEIGHTS",
"state": "OH",
"postal_code": "441205207",
"telephone_number": "216-561-0190",
"fax_number": "216-321-3408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOLLY",
"first_name": "JACQUELINE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OH",
"license": "5838",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "18845",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shaker Heights, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.