Provider Demographics
NPI:1023088424
Name:CIGRANG, JEFFREY (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:CIGRANG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15310 PROVIDENCE PIKE
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-8722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:770 W HIGH ST STE 300
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5914
Practice Address - Country:US
Practice Address - Phone:419-996-4008
Practice Address - Fax:419-996-4007
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5843103TH0100X
OHP.5834103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service