Healthcare Provider Details
I. General information
NPI: 1811175912
Provider Name (Legal Business Name): SETON FAMILY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/31/2008
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3316 WERK RD
CINCINNATI OH
45211-6844
US
IV. Provider business mailing address
3316 WERK RD
CINCINNATI OH
45211-6844
US
V. Phone/Fax
- Phone: 513-471-9169
- Fax: 513-471-9159
- Phone: 513-471-9169
- Fax: 513-471-9159
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103TC2200X |
| Taxonomy | Clinical Child & Adolescent Psychologist |
| License Number | 5639 |
| License Number State | OH |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | I 0005885 |
| License Number State | OH |
VIII. Authorized Official
Name: DR.
HELMUT
ROEHRIG
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 513-471-9169