Healthcare Provider Details

I. General information

NPI: 1467977298
Provider Name (Legal Business Name): CANDISS HOLLIE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDISS GREEN LSW

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 MADISON ROAD
CINCINNATI OH
45227-1428
US

IV. Provider business mailing address

4850 MADISON ROAD
CINCINNATI OH
45227-1428
US

V. Phone/Fax

Practice location:
  • Phone: 513-832-2884
  • Fax: 513-351-1780
Mailing address:
  • Phone: 513-832-2884
  • Fax: 513-351-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1700940
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: