Healthcare Provider Details

I. General information

NPI: 1982127197
Provider Name (Legal Business Name): STEPHANIE ALBERTZ LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 NILLES RD STE 5
FAIRFIELD OH
45014
US

IV. Provider business mailing address

1251 NILLES RD STE 5
FAIRFIELD OH
45014-7205
US

V. Phone/Fax

Practice location:
  • Phone: 513-939-0300
  • Fax: 513-939-0310
Mailing address:
  • Phone: 513-939-0300
  • Fax: 513-939-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1440250
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1700673
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: