MEDICARE: PATRICIA MCCONNELL-STEPHEN MA, MS

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	101YM0800X	Mental Health Counselor	C.1801059	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER		NONE

General Provider Information

NPI Number	:	1225505639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA MCCONNELL-STEPHEN MA, MS

Provider Business Mailing Address
First Line	:	7754 CAMARGO RD STE 19B
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45243-2661
Country	:	US
Telephone Number	:	513-299-8852
Fax Number	:

Provider Business Practice Location Address
First Line	:	7754 CAMARGO RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45243-2661
Country	:	US
Telephone Number	:	513-299-8852
Fax Number	:

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

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	01/02/2019

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