Healthcare Provider Details

I. General information

NPI: 1992002901
Provider Name (Legal Business Name): BRENDAN ROBERT HURST LISW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD MEDICAL SOCIAL SVCS RIVERSIDE HOSPITAL
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

3535 OLENTANGY RIVER RD MEDICAL SOCIAL SVCS RIVERSIDE HOSPITAL
COLUMBUS OH
43214-3908
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5397
  • Fax: 614-566-6853
Mailing address:
  • Phone: 614-566-5397
  • Fax: 614-566-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0008089
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: