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NPI Code Detail

MEDICARE: MS. BETH A DETRICH MSW, LISW-S

MEDICARE: MS. BETH A DETRICH MSW, LISW-S
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
11041C0700XClinical Social WorkerI.0004481-SUPVOH

General Provider Information

NPI Number : 1124364203
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BETH A DETRICH MSW, LISW-S
Provider Business Mailing Address
First Line : 5400 EDALBERT DR
Second Line :
City : CINCINNATI
State : OH
Zip : 45239-7604
Country : US
Telephone Number : 513-741-5690
Fax Number : 513-741-5686
Provider Business Practice Location Address
First Line : 5400 EDALBERT DR
Second Line :
City : CINCINNATI
State : OH
Zip : 45239-7604
Country : US
Telephone Number : 513-741-5690
Fax Number : 513-741-5686
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2012
Last Update Date : 12/18/2012

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