Healthcare Provider Details

I. General information

NPI: 1619484052
Provider Name (Legal Business Name): CAITLIN MURPHY DIEHL LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 DUCK CREEK RD
CINCINNATI OH
45227-1440
US

IV. Provider business mailing address

5433 WHETSEL AVE
CINCINNATI OH
45227-1739
US

V. Phone/Fax

Practice location:
  • Phone: 513-272-2800
  • Fax:
Mailing address:
  • Phone: 502-457-6199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1701109
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2102964
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: