MEDICARE: STACEY R BURGE LISW-SUPV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I.0009345-SUPV	OH

General Provider Information

NPI Number	:	1124250485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY R BURGE LISW-SUPV

Provider Business Mailing Address
First Line	:	2747 LOSANTIVILLE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45213-1265
Country	:	US
Telephone Number	:	513-633-8451
Fax Number	:	513-896-5682

Provider Business Practice Location Address
First Line	:	2747 LOSANTIVILLE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45213-1265
Country	:	US
Telephone Number	:	513-633-8451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2009
Last Update Date	:	07/24/2024

Similar Medicare Providers

1215574132 — MS. INDIA JOHNSON
Practice Location Address:

1849 FAIRMOUNT AVE
CINCINNATI, OH
45214-1265

Practice Phone: 812-977-7094
Practice Fax:

1629799697 — LIFE ESSENTIALS HOME CARE LLC.
Practice Location Address:

1849 FAIRMOUNT AVE
CINCINNATI, OH
45214-1265

Practice Phone: 859-466-6434
Practice Fax:

1487500922 — TYANNA JORDAN
Practice Location Address:

1265 PADDOCK HILLS AVE
CINCINNATI, OH
45229-1219

Practice Phone: 513-399-2996
Practice Fax:

1942203229 — CYNTHIA WOOD DEHLINGER CNM
Practice Location Address:

3590 LUCILLE DR
CINCINNATI, OH
45213-2674

Practice Phone: 513-475-7588
Practice Fax: 513-475-8598

1891799441 — GAIL L BONGIOVANNI M.D.
Practice Location Address:

3590 LUCILLE DR
CINCINNATI, OH
45213-2674

Practice Phone: 513-475-7505
Practice Fax: 513-475-7355

1437153871 — GARY S HUBER MD
Practice Location Address:

5400 KENNEDY AVE
CINCINNATI, OH
45213-2664

Practice Phone: 513-924-5300
Practice Fax: 513-924-5300

Directions to “ STACEY R BURGE LISW-SUPV” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.