Healthcare Provider Details

I. General information

NPI: 1144072059
Provider Name (Legal Business Name): MARY GAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N RIDGE RD
ELYRIA OH
44035-1241
US

IV. Provider business mailing address

2100 N RIDGE RD
ELYRIA OH
44035-1241
US

V. Phone/Fax

Practice location:
  • Phone: 440-324-1300
  • Fax: 440-277-0409
Mailing address:
  • Phone: 440-324-1300
  • Fax: 440-277-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512480
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: