MEDICARE: MARANDA J MCCRACKEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		OH

General Provider Information

NPI Number	:	1548153794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARANDA J MCCRACKEN

Provider Business Mailing Address
First Line	:	1636 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2907
Country	:	US
Telephone Number	:	419-606-3452
Fax Number	:

Provider Business Practice Location Address
First Line	:	1636 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2907
Country	:	US
Telephone Number	:	419-606-3452
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2025
Last Update Date	:	05/29/2025

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Directions to “ MARANDA J MCCRACKEN ” Practice Location

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