Healthcare Provider Details

I. General information

NPI: 1437069309
Provider Name (Legal Business Name): SUZAN D DECICCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 BURNET AVE
CINCINNATI OH
45219-2551
US

IV. Provider business mailing address

6828 MADDUX DR
CINCINNATI OH
45230-2410
US

V. Phone/Fax

Practice location:
  • Phone: 513-363-0000
  • Fax:
Mailing address:
  • Phone: 513-300-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0700709
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0700709
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberS.0700709
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: