Healthcare Provider Details

I. General information

NPI: 1245281203
Provider Name (Legal Business Name): ROSE MARIE PRYOR LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3979 DICKSON AVE
CINCINNATI OH
45229-1305
US

IV. Provider business mailing address

3979 DICKSON AVE
CINCINNATI OH
45229-1305
US

V. Phone/Fax

Practice location:
  • Phone: 513-376-6455
  • Fax:
Mailing address:
  • Phone: 513-376-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0700269
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: