Healthcare Provider Details

I. General information

NPI: 1760550032
Provider Name (Legal Business Name): PAULA J KRIVCHENIA LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 07/09/2022
Certification Date: 07/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6880 PERIMETER DR STE B
DUBLIN OH
43016-2521
US

IV. Provider business mailing address

6880 PERIMETER DR STE B
DUBLIN OH
43016-2521
US

V. Phone/Fax

Practice location:
  • Phone: 380-204-5125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberKY-1499
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1.2203720
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: