Provider Demographics
NPI:1043473002
Name:HEMMY ASAMSAMA, OCTAVIANA IMELDA PRIMA (PSYD, DRPH)
Entity Type:Individual
Prefix:DR
First Name:OCTAVIANA
Middle Name:IMELDA PRIMA
Last Name:HEMMY ASAMSAMA
Suffix:
Gender:F
Credentials:PSYD, DRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1982
Mailing Address - Country:US
Mailing Address - Phone:513-273-0450
Mailing Address - Fax:
Practice Address - Street 1:3665 ERIE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1982
Practice Address - Country:US
Practice Address - Phone:513-273-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05499103TC0700X
OHP.07904103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical