Healthcare Provider Details

I. General information

NPI: 1043701600
Provider Name (Legal Business Name): ADRIANA YODFAT GLAZER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 PLEASANT AVE
HAMILTON OH
45015-1135
US

IV. Provider business mailing address

2250 PLEASANT AVE
HAMILTON OH
45015-1135
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-4882
  • Fax: 513-868-1415
Mailing address:
  • Phone: 513-868-4882
  • Fax: 513-868-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2002298
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: