Basic Information
Provider Information
NPI: 1396369682
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CONTINI
FirstName: ROCCO
MiddleName: ANTHONY
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 700 CHILDRENS DR
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432052664
CountryCode: US
TelephoneNumber: 6147222000
FaxNumber:  
Practice Location
Address1: 399 E MAIN ST
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432155384
CountryCode: US
TelephoneNumber: 6143558550
FaxNumber: 6147223280
Other Information
ProviderEnumerationDate: 06/02/2020
LastUpdateDate: 06/01/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/01/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XC.2002595OHY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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