Healthcare Provider Details

I. General information

NPI: 1053201483
Provider Name (Legal Business Name): CHRISTINE MILLER LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4331 REGENCY RIDGE CT APT 306
CINCINNATI OH
45248-2330
US

IV. Provider business mailing address

4331 REGENCY RIDGE CT APT 306
CINCINNATI OH
45248-2330
US

V. Phone/Fax

Practice location:
  • Phone: 513-401-5525
  • Fax:
Mailing address:
  • Phone: 513-401-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1000275-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberOH3216626
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: