MEDICARE: REBECCA MARIE BORN 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
1	104100000X	Social Worker	I0600127	OH

General Provider Information

NPI Number	:	1336486919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MARIE BORN LISW-S

Provider Business Mailing Address
First Line	:	5622 WHITNEY PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-2126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5622 WHITNEY PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-2126
Country	:	US
Telephone Number	:	513-373-8239
Fax Number	:

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

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	01/15/2013

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