Provider Demographics
NPI:1073647087
Name:LACINAK, MICHAEL (LISW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LACINAK
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5967 WAYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-1703
Mailing Address - Country:US
Mailing Address - Phone:513-231-0643
Mailing Address - Fax:
Practice Address - Street 1:2061 BEECHMONT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-1688
Practice Address - Country:US
Practice Address - Phone:513-231-4501
Practice Address - Fax:513-231-4512
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0007758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health