Provider Demographics
NPI:1114558152
Name:ANCAR, MYRA EVETTE
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:EVETTE
Last Name:ANCAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 E 113TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-1829
Mailing Address - Country:US
Mailing Address - Phone:216-612-9194
Mailing Address - Fax:
Practice Address - Street 1:3513 E 113TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-1829
Practice Address - Country:US
Practice Address - Phone:216-612-9194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator