Provider Demographics
NPI:1114791480
Name:ADOMA, ESTELLA MARY
Entity Type:Individual
Prefix:
First Name:ESTELLA
Middle Name:MARY
Last Name:ADOMA
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 1:614 TREESIDE DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5626
Mailing Address - Country:US
Mailing Address - Phone:917-587-2742
Mailing Address - Fax:
Practice Address - Street 1:6161 OAK TREE BLVD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2516
Practice Address - Country:US
Practice Address - Phone:216-372-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician