Healthcare Provider Details

I. General information

NPI: 1457275372
Provider Name (Legal Business Name): ELIZABETH BOAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 FULTON AVE
CINCINNATI OH
45206-2504
US

IV. Provider business mailing address

8365 OLD STABLE RD
CINCINNATI OH
45243-1441
US

V. Phone/Fax

Practice location:
  • Phone: 513-961-4663
  • Fax: 513-818-4680
Mailing address:
  • Phone: 513-961-4663
  • Fax: 513-818-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number162462
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: