Healthcare Provider Details

I. General information

NPI: 1154480150
Provider Name (Legal Business Name): KIMBERLY MARIE METCALF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12500 REED HARTMAN HWY
CINCINNATI OH
45241-1892
US

IV. Provider business mailing address

12500 REED HARTMAN HWY
CINCINNATI OH
45241-1892
US

V. Phone/Fax

Practice location:
  • Phone: 513-402-0657
  • Fax:
Mailing address:
  • Phone: 513-402-0657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5195
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7521
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1502349-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: