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General NPI Number Information
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NPI Number | 1104766989
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Entity Type | Individual
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Provider Name | AMY BANAGA
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Gender | Female
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 521 BEALL AVE
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City | WOOSTER
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State | OH
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Zip | 44691-3589
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Country | US
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Telephone | 330-262-7836
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Fax | 330-262-2867
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Provider Business Mailing Address
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Address Line | PO BOX 72767
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City | CLEVELAND
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State | OH
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Zip | 44192-0004
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Country | US
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Telephone | 216-499-1862
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Fax | 330-668-2116
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | OH
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