Healthcare Provider Details

I. General information

NPI: 1073818357
Provider Name (Legal Business Name): CMOODY & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 DICKSON AVE
CINCINNATI OH
45229-1339
US

IV. Provider business mailing address

3909 DICKSON AVE
CINCINNATI OH
45229-1339
US

V. Phone/Fax

Practice location:
  • Phone: 513-324-2615
  • Fax: 513-751-1322
Mailing address:
  • Phone: 513-324-2615
  • Fax: 513-751-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI4207-S
License Number StateOH

VIII. Authorized Official

Name: CONNIE MOODY
Title or Position: CEO
Credential: LISW
Phone: 513-324-2615