Healthcare Provider Details

I. General information

NPI: 1457045635
Provider Name (Legal Business Name): KELLY LUCILLE LUMBERT LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 HOSBROOK RD STE 320
CINCINNATI OH
45236-2908
US

IV. Provider business mailing address

3421 MIDDLETON AVE APT 6
CINCINNATI OH
45220-1620
US

V. Phone/Fax

Practice location:
  • Phone: 513-939-0300
  • Fax:
Mailing address:
  • Phone: 513-668-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2507561
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: