Healthcare Provider Details

I. General information

NPI: 1669299335
Provider Name (Legal Business Name): DR. BROOKE MICHELLE BLUESTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 WELLINGTON PL
CINCINNATI OH
45219-1710
US

IV. Provider business mailing address

126 WELLINGTON PL
CINCINNATI OH
45219-1710
US

V. Phone/Fax

Practice location:
  • Phone: 513-444-2018
  • Fax:
Mailing address:
  • Phone: 513-444-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.08700
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: