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NPI Code Detail

MEDICARE: MS. CONDRA L. MACE LISW-S

MEDICARE: MS. CONDRA L. MACE 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
11041C0700XClinical Social WorkerI9037OH

General Provider Information

NPI Number : 1871545160
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CONDRA L. MACE LISW-S
Provider Business Mailing Address
First Line : 274 E JEFFREY PL
Second Line :
City : COLUMBUS
State : OH
Zip : 43214-1706
Country : US
Telephone Number : 614-843-0513
Fax Number :
Provider Business Practice Location Address
First Line : 2200 W BROAD ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43223-1297
Country : US
Telephone Number : 614-752-0333
Fax Number : 614-644-3871
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 12/31/2009

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