MEDICARE: MS. ELLEN S. FINCH PSYD, LISW

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	8625	OH

General Provider Information

NPI Number	:	1760483531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN S. FINCH PSYD, LISW

Provider Business Mailing Address
First Line	:	3131 S. DIXIE DRIVE
Second Line	:	SUITE 400
City	:	DAYTON
State	:	OH
Zip	:	45439
Country	:	US
Telephone Number	:	937-299-0636
Fax Number	:	937-294-4669

Provider Business Practice Location Address
First Line	:	3131 S. DIXIE DRIVE
Second Line	:	SUITE 400
City	:	DAYTON
State	:	OH
Zip	:	45439
Country	:	US
Telephone Number	:	937-299-0636
Fax Number	:	937-294-4669

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	12/28/2010

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