Provider Demographics
NPI:1447636261
Name:OGNIBENE, MARY (M ED, EDS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:OGNIBENE
Suffix:
Gender:F
Credentials:M ED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N RHODES AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3821
Mailing Address - Country:US
Mailing Address - Phone:330-989-5095
Mailing Address - Fax:330-989-5098
Practice Address - Street 1:309 N RHODES AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-3821
Practice Address - Country:US
Practice Address - Phone:330-989-5095
Practice Address - Fax:330-989-5098
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1242658103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool