Healthcare Provider Details

I. General information

NPI: 1851409312
Provider Name (Legal Business Name): MARY S. HATTEMER L.I.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 NW WASHINGTON BLVD STE A
HAMILTON OH
45013-5834
US

IV. Provider business mailing address

2201 NW WASHINGTON BLVD STE A
HAMILTON OH
45013-5834
US

V. Phone/Fax

Practice location:
  • Phone: 513-869-7000
  • Fax: 515-785-4272
Mailing address:
  • Phone: 513-869-7000
  • Fax: 515-785-4272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI0005217
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1035
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: