Provider Demographics
NPI:1972179331
Name:HARGRAVE, IRENE MARY
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:MARY
Last Name:HARGRAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:IRENE
Other - Middle Name:MARY
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1702 CRANBERRY LANE N.E. APT 159
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483
Mailing Address - Country:US
Mailing Address - Phone:330-766-5736
Mailing Address - Fax:330-856-5839
Practice Address - Street 1:238 S. MERIDIAN RD.
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509
Practice Address - Country:US
Practice Address - Phone:330-318-3416
Practice Address - Fax:330-856-5839
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRS991312OtherDRIVER LICENSE