Healthcare Provider Details

I. General information

NPI: 1154093979
Provider Name (Legal Business Name): CHELSEA HERTZENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 ELSINORE PL STE 500
CINCINNATI OH
45202-1455
US

IV. Provider business mailing address

2599 RITTENHOUSE RD
NORTH BEND OH
45052-9719
US

V. Phone/Fax

Practice location:
  • Phone: 513-231-6630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: