Healthcare Provider Details

I. General information

NPI: 1467283853
Provider Name (Legal Business Name): TIERRA RAE BARBRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 S BROADWAY
LORAIN OH
44053-3821
US

IV. Provider business mailing address

6140 S BROADWAY
LORAIN OH
44053-3821
US

V. Phone/Fax

Practice location:
  • Phone: 440-233-7232
  • Fax: 440-233-9070
Mailing address:
  • Phone: 440-233-7232
  • Fax: 440-233-9070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2513231
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: