Provider Demographics
NPI:1215080221
Name:NICELY, BARBARA ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ANNE
Last Name:NICELY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3951 ROSEMOND RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2401
Mailing Address - Country:US
Mailing Address - Phone:216-381-9541
Mailing Address - Fax:216-291-8320
Practice Address - Street 1:429 FRONT ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1716
Practice Address - Country:US
Practice Address - Phone:216-926-4921
Practice Address - Fax:440-234-2072
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5926103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2415774Medicaid
OHNICP29032Medicare ID - Type UnspecifiedPARTICIPATING PROVIDER