Provider Demographics
NPI:1427088145
Name:MIGRA, MARY MARGARET (LISW, LICDC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARGARET
Last Name:MIGRA
Suffix:
Gender:F
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 ABBE RD S
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-7246
Mailing Address - Country:US
Mailing Address - Phone:440-323-5121
Mailing Address - Fax:440-323-5134
Practice Address - Street 1:750 ABBE RD S
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-7246
Practice Address - Country:US
Practice Address - Phone:440-323-5121
Practice Address - Fax:440-323-5134
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH882483101YA0400X
OHI00092521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical