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NPI Code Detail

MEDICARE: MRS. STACY LEE LANDESBERG M.ED., PCC-S

MEDICARE: MRS. STACY LEE LANDESBERG M.ED., PCC-S
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
1101YP2500XProfessional CounselorE3969OH

General Provider Information

NPI Number : 1053414391
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACY LEE LANDESBERG M.ED., PCC-S
Provider Business Mailing Address
First Line : 8323 ARBORCREST DR
Second Line :
City : CINCINNATI
State : OH
Zip : 45236-1403
Country : US
Telephone Number : 513-792-0160
Fax Number :
Provider Business Practice Location Address
First Line : 311 ALBERT SABIN WAY
Second Line :
City : CINCINNATI
State : OH
Zip : 45229-2838
Country : US
Telephone Number : 513-558-6649
Fax Number : 513-558-3100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2006
Last Update Date : 08/07/2009

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Directions to “ MRS. STACY LEE LANDESBERG M.ED., PCC-S” Practice Location

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