MEDICARE: LISA M DEVINE MA, PCC, SC

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	E0004248	OH

General Provider Information

NPI Number	:	1689786634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M DEVINE MA, PCC, SC

Provider Business Mailing Address
First Line	:	1633 RAGLAN ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-1724
Country	:	US
Telephone Number	:	513-231-0201
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 BATAVIA PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-1518
Country	:	US
Telephone Number	:	513-752-1555
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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