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NPI Code Detail

MEDICARE: INTENTIONAL CONNECTION LLC

MEDICARE: INTENTIONAL CONNECTION 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
1104100000XSocial Worker
2171M00000XCase Manager/Care Coordinator
31041C0700XClinical Social Worker

General Provider Information

NPI Number : 1982343695
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTENTIONAL CONNECTION LLC
Provider Business Mailing Address
First Line : 1541 MARLOWE AVE APT 1
Second Line :
City : CINCINNATI
State : OH
Zip : 45224-3050
Country : US
Telephone Number : 513-512-2310
Fax Number :
Provider Business Practice Location Address
First Line : 1541 MARLOWE AVE APT 1
Second Line :
City : CINCINNATI
State : OH
Zip : 45224-3050
Country : US
Telephone Number : 513-512-2310
Fax Number :
Authorized Official
Title or Position : OWNER/SOCIAL WORK
Name : MONICA KARREEN BENTON
Credential : MSW, LSW
Telephone Number : 513-512-2310
Provider Enumeration Date : 06/01/2022
Last Update Date : 06/01/2022

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Directions to “INTENTIONAL CONNECTION LLC ” Practice Location

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