Healthcare Provider Details

I. General information

NPI: 1962534040
Provider Name (Legal Business Name): ANN G MEZIBOR MSW LSW BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11223 CORNELL PARK DRIVE
CINCINNATI OH
45242
US

IV. Provider business mailing address

11223 CORNELL PARK DRIVE
CINCINNATI OH
45242
US

V. Phone/Fax

Practice location:
  • Phone: 513-766-3307
  • Fax: 513-469-5286
Mailing address:
  • Phone: 513-766-3307
  • Fax: 513-469-5286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number30018975
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: