Healthcare Provider Details

I. General information

NPI: 1033617212
Provider Name (Legal Business Name): CANDACE M CLARRY LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 YANKEE RD, ML 16066
CINCINNATI OH
45044
US

IV. Provider business mailing address

7777 YANKEE RD ML 16066
LIBERTY TOWNSHIP OH
45044
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-9600
  • Fax: 513-636-2300
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2608220
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: