Healthcare Provider Details

I. General information

NPI: 1447636261
Provider Name (Legal Business Name): MARY OGNIBENE M. ED, EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N RHODES AVE
NILES OH
44446-3821
US

IV. Provider business mailing address

309 N RHODES AVE
NILES OH
44446-3821
US

V. Phone/Fax

Practice location:
  • Phone: 330-989-5095
  • Fax: 330-989-5098
Mailing address:
  • Phone: 330-989-5095
  • Fax: 330-989-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH1242658
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: