Healthcare Provider Details

I. General information

NPI: 1619605839
Provider Name (Legal Business Name): DENA LANDANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S MARTIN LUTHER KING JR BLVD
HAMILTON OH
45011-3216
US

IV. Provider business mailing address

820 S MARTIN LUTHER KING JR BLVD
HAMILTON OH
45011-3216
US

V. Phone/Fax

Practice location:
  • Phone: 513-887-8500
  • Fax:
Mailing address:
  • Phone: 513-887-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2310238
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.161305
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: