Healthcare Provider Details

I. General information

NPI: 1295551760
Provider Name (Legal Business Name): AEDAN LEVY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 BURNET AVE
CINCINNATI OH
45219-2426
US

IV. Provider business mailing address

3240 WHITFIELD AVE
CINCINNATI OH
45220-2310
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5801
  • Fax:
Mailing address:
  • Phone: 317-251-8386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: