Healthcare Provider Details

I. General information

NPI: 1942351325
Provider Name (Legal Business Name): CAMERON MARY PLAGENS MAATR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30400 DETROIT RD STE 105
WESTLAKE OH
44145-1855
US

IV. Provider business mailing address

24308 BRUCE RD
BAY VILLAGE OH
44140-2938
US

V. Phone/Fax

Practice location:
  • Phone: 440-871-6700
  • Fax:
Mailing address:
  • Phone: 440-773-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: