MEDICARE: OHIO OCD AND ANXIETY TREATMENT

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

General Provider Information

NPI Number	:	1932992450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO OCD AND ANXIETY TREATMENT

Provider Business Mailing Address
First Line	:	2722 ERIE AVE STE 219 PMB 727103
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31905 JACKSON RD
Second Line	:
City	:	MORELAND HILLS
State	:	OH
Zip	:	44022-1707
Country	:	US
Telephone Number	:	630-474-3272
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	SPENCER R POTESTA
Credential	:
Telephone Number	:	630-474-3272

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	05/27/2025

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