Provider Demographics
NPI:1790711869
Name:LONNEMANN, RICHARD BERNARD (QMHS, CMS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BERNARD
Last Name:LONNEMANN
Suffix:
Gender:M
Credentials:QMHS, CMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 TOLLGATE CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8688
Mailing Address - Country:US
Mailing Address - Phone:804-731-2030
Mailing Address - Fax:
Practice Address - Street 1:759 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1754
Practice Address - Country:US
Practice Address - Phone:513-751-7747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710101979101YA0400X
VA0701002138101YM0800X
VA0717000900106H00000X
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA258512 SYOtherHEALTHKEEPER COMMERCIAL
VA004945280Medicaid
VA147272 PMedicaid
VA258512 SYMedicaid
VA182407Medicaid
VA466955 DMedicaid
VA083618OtherSENTARA - COMMERCIAL
VA083618Medicaid
VA466955 SXOtherHEALTHKEEPER COMMERCIAL
VA466955 SXMedicaid