Healthcare Provider Details

I. General information

NPI: 1902636731
Provider Name (Legal Business Name): SHEILA ANN DUMFORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3629 CHURCH ST
COVINGTON KY
41015-1430
US

IV. Provider business mailing address

1780 RUSTICWOOD LN
CINCINNATI OH
45255-2456
US

V. Phone/Fax

Practice location:
  • Phone: 859-581-8974
  • Fax:
Mailing address:
  • Phone: 513-658-9368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number256476
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: