Provider Demographics
NPI:1427763887
Name:LUNDY, JOANNA L
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:L
Last Name:LUNDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 NORTHLAND BLVD APT E
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3173
Mailing Address - Country:US
Mailing Address - Phone:740-870-7590
Mailing Address - Fax:
Practice Address - Street 1:951 HARKIN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1714
Practice Address - Country:US
Practice Address - Phone:740-870-7590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11165945OtherOCCRRA