Provider Demographics
NPI:1700487006
Name:LANZILLOTTA, SUSAN MARIA
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIA
Last Name:LANZILLOTTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 CENTRAL PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45225-2302
Mailing Address - Country:US
Mailing Address - Phone:513-661-4620
Mailing Address - Fax:513-661-3661
Practice Address - Street 1:2600 VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1395
Practice Address - Country:US
Practice Address - Phone:513-751-7747
Practice Address - Fax:513-751-0180
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH090338101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)