Healthcare Provider Details

I. General information

NPI: 1699256123
Provider Name (Legal Business Name): DARYL RINGWOOD LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 01/29/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W GALBRAITH RD
CINCINNATI OH
45216-1015
US

IV. Provider business mailing address

3200 BURNET AVE
CINCINNATI OH
45229-3019
US

V. Phone/Fax

Practice location:
  • Phone: 513-821-0275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.190380
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS.1800511-TRNE
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2203341
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: