Healthcare Provider Details

I. General information

NPI: 1881149565
Provider Name (Legal Business Name): ANN MARIE MITCHELL LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE # MLC3014
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE # 5021
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4788
  • Fax: 513-517-0860
Mailing address:
  • Phone: 513-636-5278
  • Fax: 513-559-5475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3744
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0700175
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: