Healthcare Provider Details

I. General information

NPI: 1952777575
Provider Name (Legal Business Name): BREA-ANNE LAUER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BREA-ANNE WAGNER

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE # MLC5021
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4225
  • Fax:
Mailing address:
  • Phone: 513-636-4225
  • Fax: 513-636-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20043030A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP.07840
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: