Healthcare Provider Details

I. General information

NPI: 1083283592
Provider Name (Legal Business Name): TRICIA CIMINILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2021
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 YOAKAM RD
LIMA OH
45806-1144
US

IV. Provider business mailing address

3090 YOAKAM RD
LIMA OH
45806-1144
US

V. Phone/Fax

Practice location:
  • Phone: 727-483-8656
  • Fax:
Mailing address:
  • Phone: 727-483-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: