Provider Demographics
NPI:1275575904
Name:BRECKENRIDGE, NANCY (LISW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BRECKENRIDGE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30400 DETROIT RD
Mailing Address - Street 2:STE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1872
Mailing Address - Country:US
Mailing Address - Phone:440-785-4586
Mailing Address - Fax:440-250-8864
Practice Address - Street 1:30400 DETROIT RD
Practice Address - Street 2:STE 301
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1872
Practice Address - Country:US
Practice Address - Phone:440-785-4586
Practice Address - Fax:440-250-8864
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00070701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical