Healthcare Provider Details

I. General information

NPI: 1740603869
Provider Name (Legal Business Name): PATRICIA SANTORO KERREGAN LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5642 HAMILTON AVE
CINCINNATI OH
45224-3114
US

IV. Provider business mailing address

5642 HAMILTON AVE
CINCINNATI OH
45224-3114
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-9900
  • Fax:
Mailing address:
  • Phone: 513-636-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1200468
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: