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NPI Code Detail

MEDICARE: MARYBETH A RONCALLO LISW-S

MEDICARE: MARYBETH A RONCALLO 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 WorkerI.0004998-SUPVOH

General Provider Information

NPI Number : 1952367591
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYBETH A RONCALLO LISW-S
Provider Business Mailing Address
First Line : 10921 REED HARTMAN HWY
Second Line : SUITE 133
City : CINCINNATI
State : OH
Zip : 45242-2830
Country : US
Telephone Number : 513-984-9838
Fax Number : 513-984-8075
Provider Business Practice Location Address
First Line : 10921 REED HARTMAN HWY
Second Line : SUITE 133
City : CINCINNATI
State : OH
Zip : 45242-2830
Country : US
Telephone Number : 513-984-9838
Fax Number : 513-984-8075
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2006
Last Update Date : 05/23/2019

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