MEDICARE: DENISE F CROUCH LISW

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	104100000X	Social Worker	I0003423	OH

General Provider Information

NPI Number	:	1144297920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE F CROUCH LISW

Provider Business Mailing Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 5021
City	:	CINCINNATI
State	:	OH
Zip	:	45229
Country	:	US
Telephone Number	:	513-636-5013
Fax Number	:	513-636-2511

Provider Business Practice Location Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 3014
City	:	CINCINNATI
State	:	OH
Zip	:	45229
Country	:	US
Telephone Number	:	513-636-4788
Fax Number	:	513-636-4283

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	08/15/2014

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