MEDICARE: MELNEA PAIGE 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.1501229-SUPV	OH

General Provider Information

NPI Number	:	1811420037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELNEA PAIGE LISW-S

Provider Business Mailing Address
First Line	:	7672 MONTGOMERY RD # 125
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-4204
Country	:	US
Telephone Number	:	513-993-5919
Fax Number	:	513-993-5915

Provider Business Practice Location Address
First Line	:	2200 VICTORY PKWY STE 602
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2837
Country	:	US
Telephone Number	:	513-993-5919
Fax Number	:	513-993-5915

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

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	02/28/2020

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