Individual
DOUGLAS PAUL PANNETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW-S
Contact information
Practice address
8000 TOWN CENTRE DR, SUITE 300, BROADVIEW HEIGHTS, OH 44147-4030
(440) 627-6962
(440) 627-6963
Mailing address
10020 LYNN DR, NORTH ROYALTON, OH 44133-1424
(216) 406-0825
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
6801059153
MI
1041C0700X
Clinical Social Worker
Primary
I0008711
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
094872000
MAGELLAN MIS
OH
01
—
515293
VALUE OPTIONS
OH
Enumeration date
12/07/2005
Last updated
03/13/2013
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