MEDICARE: KRISTEN NAGY CDCA

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	171M00000X	Case Manager/Care Coordinator
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.181926	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770206963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN NAGY CDCA

Provider Business Mailing Address
First Line	:	6900 RIDGE RD STE 202
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44129-5650
Country	:	US
Telephone Number	:	440-887-1100
Fax Number	:	440-887-1103

Provider Business Practice Location Address
First Line	:	6900 RIDGE RD STE 202
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44129-5650
Country	:	US
Telephone Number	:	440-887-1100
Fax Number	:	440-887-1103

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

Provider Enumeration Date	:	09/22/2022
Last Update Date	:	02/02/2026

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1649015561 — BRIAN DAVID O'DONNELL
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1982327110 — MRS. KRISTEN ELIZABETH JEFFERS CDCA
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Directions to “ KRISTEN NAGY CDCA” Practice Location

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