Provider Demographics
NPI:1790903425
Name:CIAMBRO, PATRICIA A (LICDC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:CIAMBRO
Suffix:
Gender:F
Credentials:LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 S BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-6705
Mailing Address - Country:US
Mailing Address - Phone:513-424-0921
Mailing Address - Fax:513-424-4810
Practice Address - Street 1:1659 S BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6705
Practice Address - Country:US
Practice Address - Phone:513-424-0921
Practice Address - Fax:513-424-4810
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH872354101YA0400X
OHC000O835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMC0713Medicaid