Healthcare Provider Details

I. General information

NPI: 1376174516
Provider Name (Legal Business Name): SARAH ELIZABETH HUMPHREY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3229 BURNET AVE
CINCINNATI OH
45229-3018
US

IV. Provider business mailing address

725 CLIFTON COLONY DR APT 9
CINCINNATI OH
45220-2356
US

V. Phone/Fax

Practice location:
  • Phone: 423-794-9286
  • Fax:
Mailing address:
  • Phone: 423-794-9286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: