Healthcare Provider Details

I. General information

NPI: 1790831956
Provider Name (Legal Business Name): MARIAN LUSENHOP LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3253 N BEND RD
CINCINNATI OH
45239-7610
US

IV. Provider business mailing address

3253 N BEND RD
CINCINNATI OH
45239-7610
US

V. Phone/Fax

Practice location:
  • Phone: 513-662-9900
  • Fax: 513-662-9902
Mailing address:
  • Phone: 513-662-9900
  • Fax: 513-662-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0004205
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: