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General NPI Number Information
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NPI Number | 1215080221
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Entity Type | Individual
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Provider Name | BARBARA ANNE NICELY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/21/2007
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 429 FRONT ST
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City | BEREA
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State | OH
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Zip | 44017-1716
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Country | US
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Telephone | 216-926-4921
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Fax | 440-234-2072
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Provider Business Mailing Address
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Address Line | 3951 ROSEMOND RD
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City | CLEVELAND HEIGHTS
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State | OH
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Zip | 44121-2401
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Country | US
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Telephone | 216-381-9541
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Fax | 216-291-8320
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5926
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License Number State | OH
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