MEDICARE: MARIAN D KEELER CUNNINGHAM 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		OH

General Provider Information

NPI Number	:	1235482357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN D KEELER CUNNINGHAM LSW

Provider Business Mailing Address
First Line	:	2600 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1711
Country	:	US
Telephone Number	:	513-751-7747
Fax Number	:	513-751-0180

Provider Business Practice Location Address
First Line	:	115 W MCMICKEN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-4915
Country	:	US
Telephone Number	:	513-639-3743
Fax Number	:	513-123-4567

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

Provider Enumeration Date	:	10/26/2012
Last Update Date	:	10/26/2023

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