Provider Demographics
NPI:1689607632
Name:OGROCKI, PAULA K (PHD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:K
Last Name:OGROCKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5389103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH741875OtherBUCKEYE MEDICAID
OH000000510695OtherANTHEM
OH2257794Medicaid
OH363889OtherWELLCARE MEDICAID
680013776OtherMCR RR
OH000000221256OtherUNISON
OH7902809OtherAETNA
OH363889OtherWELLCARE MEDICAID
S57913Medicare UPIN
OHOGCP21353Medicare PIN