Provider Demographics
NPI:1407600588
Name:WARD BRAXTON, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:WARD BRAXTON
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 1:4057 STONEHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2612
Mailing Address - Country:US
Mailing Address - Phone:216-526-7220
Mailing Address - Fax:
Practice Address - Street 1:4415 EUCLID AVE STE 315
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-3758
Practice Address - Country:US
Practice Address - Phone:216-465-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker