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NPI Code Detail

MEDICARE: JASON ROBERT CARMODY

MEDICARE: JASON ROBERT CARMODY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor141304OH

General Provider Information

NPI Number : 1013414127
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON ROBERT CARMODY
Provider Business Mailing Address
First Line : 615 ELSINORE PL STE 300
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-1475
Country : US
Telephone Number : 513-834-7063
Fax Number :
Provider Business Practice Location Address
First Line : 2210 S RIDGE RD E
Second Line :
City : ASHTABULA
State : OH
Zip : 44004-4459
Country : US
Telephone Number : 513-834-7063
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2018
Last Update Date : 02/11/2021

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