Healthcare Provider Details

I. General information

NPI: 1023601366
Provider Name (Legal Business Name): MARISSA TAWADROS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 W NORTH BEND RD UNIT F
CINCINNATI OH
45239
US

IV. Provider business mailing address

3425 W NORTH BEND RD UNIT F
CINCINNATI OH
45239
US

V. Phone/Fax

Practice location:
  • Phone: 513-389-1067
  • Fax:
Mailing address:
  • Phone: 513-389-1067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: