Provider Demographics
NPI:1083778138
Name:DOLNICK, MICHELLE G (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:G
Last Name:DOLNICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 WELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1710
Mailing Address - Country:US
Mailing Address - Phone:513-241-6200
Mailing Address - Fax:
Practice Address - Street 1:126 WELLINGTON PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1710
Practice Address - Country:US
Practice Address - Phone:513-241-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3416103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDOCP14871Medicare ID - Type UnspecifiedMEDICARE