Healthcare Provider Details

I. General information

NPI: 1124168984
Provider Name (Legal Business Name): CARSON ASHBY WASSERMANN MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 VICTORY PKWY STE. 500
CINCINNATI OH
45206-2839
US

IV. Provider business mailing address

2330 VICTORY PKWY STE. 500
CINCINNATI OH
45206-2839
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-2330
  • Fax: 513-221-8954
Mailing address:
  • Phone: 513-221-2330
  • Fax: 513-221-8954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS0500668
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0700391
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: