Provider Demographics
NPI:1154780625
Name:GAGE, RICHARD A (LISW-S CDCA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:GAGE
Suffix:
Gender:M
Credentials:LISW-S CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3364 KOLBE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1628
Mailing Address - Country:US
Mailing Address - Phone:440-969-7960
Mailing Address - Fax:440-960-7990
Practice Address - Street 1:3364 KOLBE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1628
Practice Address - Country:US
Practice Address - Phone:440-969-7960
Practice Address - Fax:440-960-7990
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL1200268S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical