Provider Demographics
NPI:1871664102
Name:LICHTENSTEIN, ISRAEL (EDD)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:LICHTENSTEIN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5185 MUIRWOODS CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7465
Mailing Address - Country:US
Mailing Address - Phone:513-659-5143
Mailing Address - Fax:513-793-3313
Practice Address - Street 1:5185 MUIRWOODS CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7465
Practice Address - Country:US
Practice Address - Phone:513-659-5143
Practice Address - Fax:513-793-3313
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4392103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist