Organization
MODERN PSYCHIATRY & WELLNESS, LLC
Active
Organization
MODERN PSYCHIATRY & WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSANNA MARIE LOZANO LISW-S, LICDC-CS (C.O.O.)
(513) 299-4025
Entity
Organization
Contact information
Practice address
1910 FAIRGROVE AVE STE E, HAMILTON, OH 45011-1930
(513) 795-7557
(513) 795-7518
Mailing address
1910 FAIRGROVE AVE STE E, HAMILTON, OH 45011-1930
(513) 795-7557
(513) 795-7518
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0118852
—
OH
Enumeration date
07/13/2018
Last updated
10/27/2020
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