Provider Demographics
NPI:1750828828
Name:GIARDINA, SUSAN (LCDCIII)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GIARDINA
Suffix:
Gender:F
Credentials:LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7624 W CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4148
Mailing Address - Country:US
Mailing Address - Phone:513-907-7017
Mailing Address - Fax:
Practice Address - Street 1:6570 SOSNA DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2222
Practice Address - Country:US
Practice Address - Phone:513-942-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141069101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)