Healthcare Provider Details

I. General information

NPI: 1003985003
Provider Name (Legal Business Name): SCOTT A RIES LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 STETSON AVENUE
CINCINNATI OH
45219
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-7700
  • Fax: 513-558-0877
Mailing address:
  • Phone: 513-245-3107
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI0002070
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: