Provider Demographics
NPI:1164689717
Name:BENZ, DEBRA R
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:R
Last Name:BENZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 HOSBROOK RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2901
Mailing Address - Country:US
Mailing Address - Phone:513-861-9797
Mailing Address - Fax:513-861-3510
Practice Address - Street 1:8040 HOSBROOK RD
Practice Address - Street 2:SUITE 320
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2901
Practice Address - Country:US
Practice Address - Phone:513-861-9797
Practice Address - Fax:513-861-3510
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0007737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846595Medicaid