Provider Demographics
NPI:1124807318
Name:CEDENO, JOSHUA ELIJAH
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ELIJAH
Last Name:CEDENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CLOVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2205
Mailing Address - Country:US
Mailing Address - Phone:513-766-9799
Mailing Address - Fax:
Practice Address - Street 1:6100 CHANNINGWAY BLVD STE 605
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2999
Practice Address - Country:US
Practice Address - Phone:614-626-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.185910101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)