Healthcare Provider Details

I. General information

NPI: 1124446828
Provider Name (Legal Business Name): JOEL W SMITH LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 NIMITZVIEW DR SUITE 200
CINCINNATI OH
45230-4314
US

IV. Provider business mailing address

4240 HUNT RD
BLUE ASH OH
45242-6612
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-0650
  • Fax: 513-688-0591
Mailing address:
  • Phone: 513-891-0650
  • Fax: 513-891-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI1100169
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3493
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: