MEDICARE: SUSAN MARIE HAFFNER MSW, 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	104100000X	Social Worker	S.0700223	OH

General Provider Information

NPI Number	:	1710690490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARIE HAFFNER MSW, LSW

Provider Business Mailing Address
First Line	:	1533 TEAKWOOD AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2156
Country	:	US
Telephone Number	:	513-478-4631
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 TEAKWOOD AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2156
Country	:	US
Telephone Number	:	513-478-4631
Fax Number	:

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

Provider Enumeration Date	:	12/27/2022
Last Update Date	:	12/27/2022

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