Healthcare Provider Details

I. General information

NPI: 1588481451
Provider Name (Legal Business Name): CARMEN URESTI LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 KLOTZ RD
BOWLING GREEN OH
43402-4820
US

IV. Provider business mailing address

PO BOX 738
BOWLING GREEN OH
43402-0738
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-7588
  • Fax:
Mailing address:
  • Phone: 419-352-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2506322
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: