Provider Demographics
NPI:1225505639
Name:MCCONNELL-STEPHEN, PATRICIA (MA, MS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MCCONNELL-STEPHEN
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7754 CAMARGO RD STE 19B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2661
Mailing Address - Country:US
Mailing Address - Phone:513-299-8852
Mailing Address - Fax:
Practice Address - Street 1:7754 CAMARGO RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-2661
Practice Address - Country:US
Practice Address - Phone:513-299-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE