Healthcare Provider Details

I. General information

NPI: 1265452692
Provider Name (Legal Business Name): SUSAN B MELOWSKY MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 E HOLLISTER ST
CINCINNATI OH
45219-1704
US

IV. Provider business mailing address

26 E HOLLISTER ST
CINCINNATI OH
45219-1704
US

V. Phone/Fax

Practice location:
  • Phone: 513-621-5001
  • Fax: 513-621-5008
Mailing address:
  • Phone: 513-621-5001
  • Fax: 513-621-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI1788
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: