Provider Demographics
NPI:1114475258
Name:BRAGG-BARNES, JANE (CDCA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BRAGG-BARNES
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41641 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1264
Mailing Address - Country:US
Mailing Address - Phone:440-324-7406
Mailing Address - Fax:440-324-3609
Practice Address - Street 1:41641 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1264
Practice Address - Country:US
Practice Address - Phone:440-324-7406
Practice Address - Fax:440-324-3609
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.182896101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)