Healthcare Provider Details

I. General information

NPI: 1871505115
Provider Name (Legal Business Name): CISTY JANE KARACIA MSSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 IRONGATE PARK DR
CENTERVILLE FINANCE OH
45459-4616
US

IV. Provider business mailing address

23 IRONGATE PARK DR
CENTERVILLE FINANCE OH
45459-4616
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-1600
  • Fax: 937-436-2467
Mailing address:
  • Phone: 937-436-1600
  • Fax: 937-436-2467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0006057
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: