Healthcare Provider Details

I. General information

NPI: 1326759168
Provider Name (Legal Business Name): SAMUEL HARRISON BAKER-ROMANS LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6331 GLENWAY AVE
CINCINNATI OH
45211-6301
US

IV. Provider business mailing address

6331 GLENWAY AVE
CINCINNATI OH
45211-6301
US

V. Phone/Fax

Practice location:
  • Phone: 513-346-1270
  • Fax: 513-346-1281
Mailing address:
  • Phone: 513-346-1270
  • Fax: 513-346-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2410368
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: