Healthcare Provider Details

I. General information

NPI: 1316780455
Provider Name (Legal Business Name): JAMIE DANIELLA HARDY-BESAW M.P.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE DANIELLA BESAW

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 BURNET AVE
CINCINNATI OH
45219-2426
US

IV. Provider business mailing address

742 S FORT THOMAS AVE APT 2N
FORT THOMAS KY
41075-2249
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5857
  • Fax:
Mailing address:
  • Phone: 614-288-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: