Healthcare Provider Details

I. General information

NPI: 1689415986
Provider Name (Legal Business Name): NICYAA FITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 SHAKER BLVD
CLEVELAND OH
44104-3869
US

IV. Provider business mailing address

26241 LAKE SHORE BLVD APT 1452
EUCLID OH
44132-1145
US

V. Phone/Fax

Practice location:
  • Phone: 216-417-8813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: