Healthcare Provider Details

I. General information

NPI: 1538548623
Provider Name (Legal Business Name): MARIANA FREESE MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANA LUNA

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 FAIRFAX AVE
CINCINNATI OH
45207-1943
US

IV. Provider business mailing address

3333 BURNET AVENUE MLC 3014
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-363-7800
  • Fax: 513-363-7820
Mailing address:
  • Phone: 513-636-4788
  • Fax: 513-517-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34008101A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1901539
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.1901539-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: