Healthcare Provider Details

I. General information

NPI: 1518109784
Provider Name (Legal Business Name): PATRICIA J BENNETT CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 READING RD
CINCINNATI OH
45229-1215
US

IV. Provider business mailing address

2600 VICTORY PKWY
CINCINNATI OH
45206-1711
US

V. Phone/Fax

Practice location:
  • Phone: 513-641-4300
  • Fax: 513-482-6922
Mailing address:
  • Phone: 513-751-7747
  • Fax: 513-872-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCERT #060218
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: