Provider Demographics
NPI:1225547334
Name:SERRECCHIA, WHITNEY MAE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MAE
Last Name:SERRECCHIA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 AICHOLTZ ROAD,
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244
Mailing Address - Country:US
Mailing Address - Phone:513-732-8800
Mailing Address - Fax:
Practice Address - Street 1:4629 AICHOLTZ ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244
Practice Address - Country:US
Practice Address - Phone:513-752-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2203903-TRNE104100000X
171M00000X
OHC.2204737101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0479296Medicaid