Provider Demographics
NPI:1609968072
Name:FRAGAPANE, DONNA (ATR-BC, LICDC, PC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:FRAGAPANE
Suffix:
Gender:F
Credentials:ATR-BC, LICDC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3951 WILTSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:MORELAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-1152
Mailing Address - Country:US
Mailing Address - Phone:440-785-0198
Mailing Address - Fax:440-247-6532
Practice Address - Street 1:30400 DETROIT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1872
Practice Address - Country:US
Practice Address - Phone:440-785-0198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH991605101YA0400X
OHC0500702101YP2500X
OH03-172221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist