MEDICARE: AMITA GHOSH M.ED.

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
1	101YP2500X	Professional Counselor	E.1700375	OH
2	101YP2500X	Professional Counselor	103440	KY

General Provider Information

NPI Number	:	1447203906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMITA GHOSH M.ED.

Provider Business Mailing Address
First Line	:	428 8 MILE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-4619
Country	:	US
Telephone Number	:	859-391-1255
Fax Number	:

Provider Business Practice Location Address
First Line	:	1407 ALEXANDRIA PIKE
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-2599
Country	:	US
Telephone Number	:	859-391-1255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	12/12/2018

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