Healthcare Provider Details

I. General information

NPI: 1649226861
Provider Name (Legal Business Name): MARCIA Y NIENABER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S FORT THOMAS AVE
FORT THOMAS KY
41075-2421
US

IV. Provider business mailing address

502 FARRELL DR
COVINGTON KY
41011-3717
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-5596
  • Fax: 859-781-5013
Mailing address:
  • Phone: 859-331-3292
  • Fax: 859-578-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3903
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: