Healthcare Provider Details

I. General information

NPI: 1770092124
Provider Name (Legal Business Name): LISA M HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E MAIN ST
COLUMBUS OH
43205-2140
US

IV. Provider business mailing address

6460 HARRISON AVE
CINCINNATI OH
45247-7957
US

V. Phone/Fax

Practice location:
  • Phone: 614-252-0731
  • Fax:
Mailing address:
  • Phone: 513-467-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1700441
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: