Healthcare Provider Details

I. General information

NPI: 1437880895
Provider Name (Legal Business Name): CHRISTOPHER MILLER DEARTH SOCIAL WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 WESTBOURNE DR
CINCINNATI OH
45248-5107
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT RD
CINCINNATI OH
45219-2610
US

V. Phone/Fax

Practice location:
  • Phone: 513-674-1400
  • Fax:
Mailing address:
  • Phone: 513-351-9900
  • Fax: 513-366-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.0800154
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0800154
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: