Provider Demographics
NPI:1316780455
Name:HARDY-BESAW, JAMIE DANIELLA (MPS)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:DANIELLA
Last Name:HARDY-BESAW
Suffix:
Gender:F
Credentials:MPS
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:DANIELLA
Other - Last Name:BESAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:742 S FORT THOMAS AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2249
Mailing Address - Country:US
Mailing Address - Phone:614-288-0985
Mailing Address - Fax:
Practice Address - Street 1:2825 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2426
Practice Address - Country:US
Practice Address - Phone:513-558-5857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist