MEDICARE: MELODIE L HERNANDEZ CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	188168	OH

General Provider Information

NPI Number	:	1104317486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODIE L HERNANDEZ CDCA

Provider Business Mailing Address
First Line	:	3501 W STATE ROUTE 22 3 APT 3
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-3508
Country	:	US
Telephone Number	:	513-225-7736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521 WALMART DR STE 901
Second Line	:
City	:	LEBANON
State	:	OH
Zip	:	45036-8359
Country	:	US
Telephone Number	:	513-225-7736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	08/20/2024

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Directions to “ MELODIE L HERNANDEZ CDCA” Practice Location

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