Provider Demographics
NPI:1821000118
Name:MAKRINOS, STANLEY (PCC-SUPV)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:
Last Name:MAKRINOS
Suffix:
Gender:M
Credentials:PCC-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3268 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2220
Mailing Address - Country:US
Mailing Address - Phone:513-708-8188
Mailing Address - Fax:513-677-6624
Practice Address - Street 1:3268 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2220
Practice Address - Country:US
Practice Address - Phone:513-708-8188
Practice Address - Fax:513-708-8188
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003935101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0244770Medicaid