MEDICARE: MR. JAMES J CANFIELD 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	1041C0700X	Clinical Social Worker	I.0009369.SUPV	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	H130910	OTHER	OH	MEDICARE PTAN GROUP ACCESS COUNSELING SERVICES, LLC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0074861	OTHER	OH	OHIO DEPT. OF ALCOHOL & DRUG ADDICTION SERVICES (GROUP)
2	0074946	OTHER	OH	OHIO DEPT. OF MENTAL HEALTH (GROUP)
3	01-0693	OTHER	OH	CARF CERTIFIED ACCREDITATION

General Provider Information

NPI Number	:	1487750428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES J CANFIELD LISW-S

Provider Business Mailing Address
First Line	:	8040 HOSBROOK RD STE 320
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2908
Country	:	US
Telephone Number	:	513-861-9797
Fax Number	:	513-861-3510

Provider Business Practice Location Address
First Line	:	8040 HOSBROOK RD STE 320
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2908
Country	:	US
Telephone Number	:	513-861-9797
Fax Number	:	513-861-3510

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	05/08/2018

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