Provider Demographics
NPI:1376899377
Name:MOELL, DENNIS MICHAEL JR
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MICHAEL
Last Name:MOELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 KENNEDYS LNDG UNIT 3
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-5131
Mailing Address - Country:US
Mailing Address - Phone:513-707-2029
Mailing Address - Fax:
Practice Address - Street 1:764 CLOUGH PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1726
Practice Address - Country:US
Practice Address - Phone:513-620-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI1302810S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical