Provider Demographics
NPI:1801203401
Name:BANGO, EMMA CATHERINE C PITCHFORD (LPCC, ATR)
Entity Type:Individual
Prefix:
First Name:EMMA CATHERINE
Middle Name:C PITCHFORD
Last Name:BANGO
Suffix:
Gender:F
Credentials:LPCC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 MAPLEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-2447
Mailing Address - Country:US
Mailing Address - Phone:601-260-7984
Mailing Address - Fax:
Practice Address - Street 1:1384 W 117TH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3011
Practice Address - Country:US
Practice Address - Phone:216-221-7588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1400266251B00000X
OHE.1700122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871101Medicaid