Healthcare Provider Details

I. General information

NPI: 1962857029
Provider Name (Legal Business Name): DARLENE NEAL LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 ATLANTIC AVE
CINCINNATI OH
45209-2001
US

IV. Provider business mailing address

2741 ATLANTIC AVE
CINCINNATI OH
45209-2001
US

V. Phone/Fax

Practice location:
  • Phone: 513-254-1362
  • Fax:
Mailing address:
  • Phone: 513-254-1362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberI.0008902
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0008902-SUPV
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: