Provider Demographics
NPI:1194441436
Name:NGWA, GLADIS BERI
Entity type:Individual
Prefix:
First Name:GLADIS
Middle Name:BERI
Last Name:NGWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-1300
Mailing Address - Country:US
Mailing Address - Phone:513-207-0064
Mailing Address - Fax:
Practice Address - Street 1:2489 WILSON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-1300
Practice Address - Country:US
Practice Address - Phone:513-207-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000308336Medicaid