Healthcare Provider Details

I. General information

NPI: 1194230623
Provider Name (Legal Business Name): CARA CHRISTINE BUENZ LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 S WALL ST
COLUMBUS OH
43206-1921
US

IV. Provider business mailing address

855 S WALL ST
COLUMBUS OH
43206-1921
US

V. Phone/Fax

Practice location:
  • Phone: 614-664-7270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2203658-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: