Healthcare Provider Details

I. General information

NPI: 1700410800
Provider Name (Legal Business Name): ENZA MARCINE HILL LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S EDWIN C MOSES BLVD
DAYTON OH
45417-3464
US

IV. Provider business mailing address

921 S EDWIN C MOSES BLVD
DAYTON OH
45417-3464
US

V. Phone/Fax

Practice location:
  • Phone: 937-461-1376
  • Fax: 937-461-9280
Mailing address:
  • Phone: 937-461-1376
  • Fax: 937-461-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0029197
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: