Healthcare Provider Details

I. General information

NPI: 1235854100
Provider Name (Legal Business Name): RANIA DAMRA CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 CORPORATE DR STE 101
LEXINGTON KY
40503-5461
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9058
US

V. Phone/Fax

Practice location:
  • Phone: 859-971-2585
  • Fax: 859-971-7594
Mailing address:
  • Phone: 419-695-8010
  • Fax: 419-932-6232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number257295
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: