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NPI Code Detail

MEDICARE: TIFFANY ROSE CERQUA

MEDICARE: TIFFANY ROSE CERQUA
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) CounselorLCDCII.161455OH
2101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.140219OH
3101YA0400XAddiction (Substance Use Disorder) CounselorLCDCIII.162057OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861801706
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY ROSE CERQUA
Provider Business Mailing Address
First Line : 6460 HARRISON AVE STE 200
Second Line :
City : CINCINNATI
State : OH
Zip : 45247-7958
Country : US
Telephone Number : 513-941-4999
Fax Number :
Provider Business Practice Location Address
First Line : 25 WHITNEY DR STE 122
Second Line :
City : MILFORD
State : OH
Zip : 45150-8400
Country : US
Telephone Number : 513-941-4999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2014
Last Update Date : 11/12/2024

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1679936181 — MEGAN RENEA JOHNSON LPCC-S, LICDC-CS
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1669911285 — DEREK R. JORDAN
Practice Location Address:
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Practice Fax: 513-694-0168

Directions to “ TIFFANY ROSE CERQUA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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