Provider Demographics
NPI:1952646614
Name:RITZ, BRENDA KAYE (PMH-CNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:KAYE
Last Name:RITZ
Suffix:
Gender:F
Credentials:PMH-CNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1834
Mailing Address - Country:US
Mailing Address - Phone:330-759-2310
Mailing Address - Fax:330-759-0018
Practice Address - Street 1:2980 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1834
Practice Address - Country:US
Practice Address - Phone:330-759-2310
Practice Address - Fax:330-759-0018
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.274471-COA1364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0118604Medicaid
OH0118604Medicaid