Healthcare Provider Details

I. General information

NPI: 1477573525
Provider Name (Legal Business Name): IOLA SHELIA GREEN MSSW,LMSW,CCJS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

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

3200 VINE ST
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

11 FOX CHASE LN APT 6
SOUTHGATE KY
41071-5422
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-3100
  • Fax: 859-572-6222
Mailing address:
  • Phone: 859-781-6095
  • Fax: 859-572-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801082768
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: