Basic Information
| Provider Information | |||||||||
| NPI: | 1124756937 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROGAN | ||||||||
| FirstName: | BAILEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6383 SOMERSET DR | ||||||||
| Address2: | |||||||||
| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440704846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169064092 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1865 N RIDGE RD E STE A | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440553359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403241300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2022 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.