Healthcare Provider Details

I. General information

NPI: 1780163816
Provider Name (Legal Business Name): CARMEN NANTWI LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 E MAIN ST
COLUMBUS OH
43205-2081
US

IV. Provider business mailing address

2157 RIVERDALE SQ W
COLUMBUS OH
43232-4076
US

V. Phone/Fax

Practice location:
  • Phone: 565-312-8700
  • Fax:
Mailing address:
  • Phone: 330-351-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2506685
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: