Healthcare Provider Details

I. General information

NPI: 1053452235
Provider Name (Legal Business Name): MOLLIE ELIZABETH SNYDER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

4760 GREEN BELT DR
CLEVES OH
45002-9102
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-6329
  • Fax:
Mailing address:
  • Phone: 513-467-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0600162
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: