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NPI Code Detail

MEDICARE: JACOB L MUNZ LISW-S, LCDC III

MEDICARE: JACOB L MUNZ LISW-S, LCDC III
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
11041C0700XClinical Social WorkerI.2405359-SUPVOH

General Provider Information

NPI Number : 1528402740
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB L MUNZ LISW-S, LCDC III
Provider Business Mailing Address
First Line : 25 WHITNEY DR STE 122
Second Line :
City : MILFORD
State : OH
Zip : 45150-8400
Country : US
Telephone Number : 513-753-9964
Fax Number : 513-753-9968
Provider Business Practice Location Address
First Line : 25 WHITNEY DRIVE SUITE 122
Second Line :
City : MILFORD
State : OH
Zip : 45150-8400
Country : US
Telephone Number : 513-753-9964
Fax Number : 513-753-9968
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2013
Last Update Date : 03/18/2026

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