Healthcare Provider Details

I. General information

NPI: 1053901199
Provider Name (Legal Business Name): K.N.E.W YOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 W GALBRAITH RD
CINCINNATI OH
45239-4753
US

IV. Provider business mailing address

3254 BANNING RD
CINCINNATI OH
45239-5207
US

V. Phone/Fax

Practice location:
  • Phone: 513-371-1787
  • Fax:
Mailing address:
  • Phone: 513-289-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC ALEXANDER ROBINSON JR.
Title or Position: OWNER/CEO
Credential:
Phone: 513-289-8874