Provider Demographics
NPI:1467968644
Name:MYERS, CECELIA MONIQUE (INTERVENTION)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:MONIQUE
Last Name:MYERS
Suffix:
Gender:F
Credentials:INTERVENTION
Other - Prefix:
Other - First Name:CECELIA
Other - Middle Name:MONIQUE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:INTERVENTION SPECIAL
Mailing Address - Street 1:2715 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-3152
Mailing Address - Country:US
Mailing Address - Phone:330-261-8633
Mailing Address - Fax:
Practice Address - Street 1:2715 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-3152
Practice Address - Country:US
Practice Address - Phone:330-261-8633
Practice Address - Fax:330-261-8633
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-24
Last Update Date:2017-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health