Healthcare Provider Details

I. General information

NPI: 1104766989
Provider Name (Legal Business Name): AMY BANAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 BEALL AVE
WOOSTER OH
44691-3589
US

IV. Provider business mailing address

PO BOX 72767
CLEVELAND OH
44192-0004
US

V. Phone/Fax

Practice location:
  • Phone: 330-262-7836
  • Fax: 330-262-2867
Mailing address:
  • Phone: 216-499-1862
  • Fax: 330-668-2116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: