Basic Information
| Provider Information | |||||||||
| NPI: | 1003276288 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARIAGE | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | MA, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25613 EATON WAY | ||||||||
| Address2: | |||||||||
| City: | BAY VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441402502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406554431 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10427 DETROIT AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441021645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165216511 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2016 | ||||||||
| LastUpdateDate: | 03/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1500402 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.