Healthcare Provider Details

I. General information

NPI: 1861573180
Provider Name (Legal Business Name): ANGELA J UPTON LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 MOUNT CARMEL TOBASCO RD
CINCINNATI OH
45255-3400
US

IV. Provider business mailing address

5642 HAMILTON AVE ML 6015
CINCINNATI OH
45224-3114
US

V. Phone/Fax

Practice location:
  • Phone: 513-528-9200
  • Fax: 513-870-0818
Mailing address:
  • Phone: 513-636-0847
  • Fax: 513-636-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1-0004906
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: