Healthcare Provider Details

I. General information

NPI: 1902758360
Provider Name (Legal Business Name): CASEY LEE KUZNICZCI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7820 REDSKY DR
CINCINNATI OH
45249-1632
US

IV. Provider business mailing address

7675 STYRAX LN
CINCINNATI OH
45236-3225
US

V. Phone/Fax

Practice location:
  • Phone: 513-951-5553
  • Fax: 443-450-9366
Mailing address:
  • Phone: 513-419-9785
  • Fax: 443-450-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number190954
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: