Healthcare Provider Details

I. General information

NPI: 1407778525
Provider Name (Legal Business Name): ANNALISE LONGFELLOW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S 2ND ST
HAMILTON OH
45011-2811
US

IV. Provider business mailing address

PO BOX 837
HAMILTON OH
45012-0837
US

V. Phone/Fax

Practice location:
  • Phone: 513-454-1111
  • Fax:
Mailing address:
  • Phone: 513-454-1111
  • Fax: 513-737-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2613957
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: