Provider Demographics
NPI:1548280290
Name:MARBURY, JA'NITTA (PHD, PCC-S)
Entity type:Individual
Prefix:DR
First Name:JA'NITTA
Middle Name:
Last Name:MARBURY
Suffix:
Gender:F
Credentials:PHD, PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5589 DUNHAM RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3657
Mailing Address - Country:US
Mailing Address - Phone:216-371-3420
Mailing Address - Fax:216-371-3430
Practice Address - Street 1:5589 DUNHAM RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3657
Practice Address - Country:US
Practice Address - Phone:216-371-3420
Practice Address - Fax:216-371-3430
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0500062-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2585582Medicaid
2598130OtherUNITED HEALTHCARE
7931741OtherAETNA
000000329113OtherBCBS
1000694OtherQUALCHOICE
724645000OtherMAGELLAN