Healthcare Provider Details

I. General information

NPI: 1871972570
Provider Name (Legal Business Name): ERIC DEAN MSW, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 CINTI BATAVIA PIKE
CINCINNATI OH
45244-1518
US

IV. Provider business mailing address

551 CINTI BATAVIA PIKE
CINCINNATI OH
45244-1518
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax: 513-753-2144
Mailing address:
  • Phone: 513-752-1555
  • Fax: 513-753-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1500190
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: