Healthcare Provider Details

I. General information

NPI: 1245637099
Provider Name (Legal Business Name): CHARLES WORKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 VICTORY PARKWAY
CINCINNATI OH
45206
US

IV. Provider business mailing address

11 HUCKLEBERRY HILL #3
FORT MITCHELL KY
41017
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-4673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0032196
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: