Healthcare Provider Details

I. General information

NPI: 1972060879
Provider Name (Legal Business Name): BREANNA WARE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BREANNA NAGI

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 WOODLAND ST NE
WARREN OH
44483-5348
US

IV. Provider business mailing address

1705 WOODLAND ST NE
WARREN OH
44483-5348
US

V. Phone/Fax

Practice location:
  • Phone: 330-797-0070
  • Fax:
Mailing address:
  • Phone: 330-797-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.171529
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: