Healthcare Provider Details

I. General information

NPI: 1699335489
Provider Name (Legal Business Name): CYRIL ABDIEL-CANDOR LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 REED HARTMAN HWY STE 133
BLUE ASH OH
45242-2851
US

IV. Provider business mailing address

10921 REED HARTMAN HWY STE 133
BLUE ASH OH
45242-2851
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-9838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2309569
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: