Individual provider Active NPI

Susan Boyd, LICDC

  • Addiction (Substance Use Disorder) Counselor
  • Cincinnati, OH
National Provider Identifier
1801348230
Registry record updated Jun 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
LICDC.161963 Issued in OH
Practice address
1805 Dalton Ave
Cincinnati, OH 45214-2055
Phone
(513) 494-4649
NPI assigned
Nov 2, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X LPN096352.MEDS OH
Addiction (Substance Use Disorder) Counselor 101YA0400X LICDC.161963 OH Primary

Addresses

Primary practice location

1805 Dalton Ave
Cincinnati, OH 45214-2055

Mailing address

1910 Fairgrove Ave Ste E
Hamilton, OH 45011-1930
Phone (513) 494-4679

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250818002202 OH Practitioner - Mental Health Counselor 7719486679 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1910 Fairgrove Ave
Suite E
Hamilton, OH 45011-1930

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LPN096352.MEDSOHMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Modern Psychiatry & Wellness, LLC CurrentSince Jun 7, 2025 Accepting new patients
Modern Psychiatry and Wellness LLC CurrentSince Jun 7, 2025 Accepting new patients

Locations

1910 Fairgrove Ave
Ste E
Hamilton, OH 45011
Phone (513) 299-4025

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/5507/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.qualifacts.org/api/fhir/mpwhealth/r4/

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750377600000",
    "number": "1801348230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 FAIRGROVE AVE STE E",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450111930",
            "telephone_number": "513-494-4679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 DALTON AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452142055",
            "telephone_number": "513-494-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYD",
        "first_name": "SUSAN",
        "credential": "LICDC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-02",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "LPN096352.MEDS",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LICDC.161963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.