Provider Demographics
NPI:1225169386
Name:DUGAN, AMY KATHLEEN (MSSA LISW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KATHLEEN
Last Name:DUGAN
Suffix:
Gender:F
Credentials:MSSA LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 DUGAN FARMS ROAD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OH
Mailing Address - Zip Code:44081
Mailing Address - Country:US
Mailing Address - Phone:440-259-4153
Mailing Address - Fax:
Practice Address - Street 1:9652 OLD JOHNNYCAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6521
Practice Address - Country:US
Practice Address - Phone:440-352-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI83061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical