Basic Information
| Provider Information | |||||||||
| NPI: | 1851525604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAGLEBY | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3250 W MARKET ST | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443333336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308739516 | ||||||||
| FaxNumber: | 3308648678 | ||||||||
| Practice Location | |||||||||
| Address1: | 3094 W MARKET ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443333624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307036316 | ||||||||
| FaxNumber: | 2166965768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2009 | ||||||||
| LastUpdateDate: | 09/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 6499 | OH | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.