MEDICARE: CINCINNATI CHILD NEUROPSYCHOLOGY, LLC

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1942018916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CINCINNATI CHILD NEUROPSYCHOLOGY, LLC

Provider Business Mailing Address
First Line	:	7681 TYLERS PLACE BLVD STE 2
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-6393
Country	:	US
Telephone Number	:	513-589-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	7681 TYLERS PLACE BLVD STE 2
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-6393
Country	:	US
Telephone Number	:	513-589-0900
Fax Number	:

Authorized Official
Title or Position	:	NEUROPSYCHOLOGIST
Name	:	DR. BRENNA LEJEUNE
Credential	:	PHD
Telephone Number	:	513-589-0900

Provider Enumeration Date	:	12/23/2024
Last Update Date	:	12/23/2024

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