Healthcare Provider Details

I. General information

NPI: 1427490085
Provider Name (Legal Business Name): MICHAEL MATTHEW ROSEN PCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 NORTHLAND BLVD
CINCINNATI OH
45240-3248
US

IV. Provider business mailing address

830 EZZARD CHARLES DR
CINCINNATI OH
45214-2525
US

V. Phone/Fax

Practice location:
  • Phone: 513-941-4999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0900274
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: