Provider Demographics
NPI:1710577374
Name:PUGH, DANA MAURICE
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:MAURICE
Last Name:PUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 WARRENSVILLE CENTER RD APT 229
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6367
Mailing Address - Country:US
Mailing Address - Phone:216-849-5573
Mailing Address - Fax:
Practice Address - Street 1:2114 NOBLE RD
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1725
Practice Address - Country:US
Practice Address - Phone:216-268-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program