Active NPI
Todd Provenzano, LPCC-S
- Mental Health Counselor
- Cincinnati, OH
National Provider Identifier
1477086395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- E.0004366-SUPV
- Practice address
- 4721 Reading Rd
Cincinnati, OH 45237-6107 - Phone
- (513) 242-7600
- NPI assigned
- Apr 7, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | E.0004366-SUPV | OH | Primary |
Addresses
Primary practice location
4721 Reading Rd
Cincinnati, OH 45237-6107
Mailing address
4721 Reading Rd
Cincinnati, OH 45237-6107
Phone (513) 242-7600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E.0004366-SUPV | OH | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491523200000",
"number": "1477086395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4721 READING RD",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452376107",
"telephone_number": "513-242-7600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4721 READING RD",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452376107",
"telephone_number": "513-242-7600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVENZANO",
"first_name": "TODD",
"credential": "LPCC-S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-04-07",
"last_updated": "2017-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OH",
"license": "E.0004366-SUPV",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cincinnati, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.