Healthcare Provider Details

I. General information

NPI: 1841935525
Provider Name (Legal Business Name): MRS. AMANDA MCDERMOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6881 BEECHMONT AVE
CINCINNATI OH
45230-2907
US

IV. Provider business mailing address

706 NOYES AVE
HAMILTON OH
45015-2027
US

V. Phone/Fax

Practice location:
  • Phone: 513-231-6630
  • Fax:
Mailing address:
  • Phone: 513-344-0849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: