Healthcare Provider Details

I. General information

NPI: 1346681905
Provider Name (Legal Business Name): CYNTHIA E CHIZEWICK MSW, LISW-S,LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 BEECHMONT AVE
CINCINNATI OH
45255-4222
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT RD
CINCINNATI OH
45219-2610
US

V. Phone/Fax

Practice location:
  • Phone: 513-564-4026
  • Fax: 513-564-4027
Mailing address:
  • Phone: 877-651-4343
  • Fax: 513-366-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0801020
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI500616
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: