Provider Demographics
NPI:1982343695
Name:INTENTIONAL CONNECTION LLC
Entity Type:Organization
Organization Name:INTENTIONAL CONNECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOCIAL WORK
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:KARREEN
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW
Authorized Official - Phone:513-512-2310
Mailing Address - Street 1:1541 MARLOWE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-3050
Mailing Address - Country:US
Mailing Address - Phone:513-512-2310
Mailing Address - Fax:
Practice Address - Street 1:1541 MARLOWE AVE APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-3050
Practice Address - Country:US
Practice Address - Phone:513-512-2310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty