Shaina A Duffy, LPCC
Individual provider Active NPI Professional Counselor · North Ridgeville, OH
NPI 1760895445 · NPPES record last updated Jun 25, 2019
Key facts
- NPI
- 1760895445
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- E1700389 (OH)
- Practice address
- 33480 Liberty Pkwy
North Ridgeville, OH 44039-2670 - Phone
- (440) 732-5252
- Fax
- (440) 202-6252
- NPI assigned
- Jun 10, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2013
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Phoenix Counseling Center LLC
Practice addresses (Care Compare)
33480 Liberty Pkwy
North Ridgeville, OH 44039-2670
Phone (440) 732-5252
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240412000738 | OH | Practitioner - Mental Health Counselor | 0749629624 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C 110491 | OH | MD | Counselor |
| E1700389 | OH | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoenix Counseling Center LLC | Professional | Current |
Accepting new patients |
| Phoenix Counseling Center LLC | Past | Accepting new patients | |
| Phoenix Counseling Center LLC | Past | Accepting new patients |
Locations
33480 Liberty Pkwy
North Ridgeville, OH 44039
Phone (440) 732-5252
6180 Emerald St
North Ridgeville, OH 44039
Phone (216) 327-7372
23550 Center Ridge Rd
Ste 102
Westlake, OH 44145
Phone (440) 732-5252
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | C 110491 | OH | |
| Professional Counselor | 101YP2500X | E1700389 | OH | Yes |
Addresses
Primary practice location
33480 Liberty Pkwy
North Ridgeville, OH 44039-2670
Mailing address
33480 Liberty Pkwy
North Ridgeville, OH 44039-2670
Phone (440) 732-5252
Other providers in North Ridgeville, OH
- Lisa Marina Dibello
- Nila Disantis
- Discount Drug Mart Inc
- David Gary Dixon
- Duber Medical, Inc
- Courtney G. Dunfee
- John M. Ellis
- Emh Professional Services
- Thomas Michael Evans II
- Alise M Excell
All providers in North Ridgeville, OH · Professional Counselor in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.