Healthcare Provider Details

I. General information

NPI: 1063886273
Provider Name (Legal Business Name): RACHEL RUSSO STRUNK LISW-S, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 PENDLETON ST STE 400
CINCINNATI OH
45202-8805
US

IV. Provider business mailing address

1118 PENDLETON ST STE 400
CINCINNATI OH
45202-8805
US

V. Phone/Fax

Practice location:
  • Phone: 513-356-9446
  • Fax: 513-206-9681
Mailing address:
  • Phone: 513-356-9446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.161911
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1801112-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: