Healthcare Provider Details

I. General information

NPI: 1154920312
Provider Name (Legal Business Name): JANETTE BURNSWORTH CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 N DETROIT ST STE 105
SUGARCREEK TOWNSHIP OH
45385-2963
US

IV. Provider business mailing address

100 CROWNE POINT PL
CINCINNATI OH
45241-5427
US

V. Phone/Fax

Practice location:
  • Phone: 937-610-4673
  • Fax: 937-736-2615
Mailing address:
  • Phone: 513-743-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number163601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: