Provider Demographics
NPI:1821374406
Name:BAZIE, MARY I (MSSA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:I
Last Name:BAZIE
Suffix:
Gender:F
Credentials:MSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARE ALLIANCE HEALTH CENTER
Mailing Address - Street 2:2916 CENTRAL AVE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3229
Mailing Address - Country:US
Mailing Address - Phone:216-535-9100
Mailing Address - Fax:216-535-2626
Practice Address - Street 1:CARE ALLIANCE HEALTH CENTER
Practice Address - Street 2:2916 CENTRAL AVE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3229
Practice Address - Country:US
Practice Address - Phone:216-535-9100
Practice Address - Fax:216-535-2626
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.0700319101YA0400X
104100000X
OHI.0700319-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217599Medicaid