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NPI Code Detail

MEDICARE: ANDRE WHALEY LSW

MEDICARE: ANDRE WHALEY LSW
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
1104100000XSocial WorkerS1450860OH

General Provider Information

NPI Number : 1215467345
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDRE WHALEY LSW
Provider Business Mailing Address
First Line : 820 S MARTIN LUTHER KING JR BLVD
Second Line :
City : HAMILTON
State : OH
Zip : 45011-3216
Country : US
Telephone Number : 513-887-8500
Fax Number : 513-737-8196
Provider Business Practice Location Address
First Line : 1585 COMPTON RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45231-3427
Country : US
Telephone Number : 513-541-1699
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2017
Last Update Date : 06/06/2023

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