Healthcare Provider Details

I. General information

NPI: 1679643969
Provider Name (Legal Business Name): MARTHA ELIZABETH MCLEOD M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 WOOLPER AVE
CINCINNATI OH
45220-1217
US

IV. Provider business mailing address

211 WOOLPER AVE
CINCINNATI OH
45220-1217
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-8623
  • Fax: 513-221-8623
Mailing address:
  • Phone: 513-221-8623
  • Fax: 513-221-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI4537
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: