Healthcare Provider Details

I. General information

NPI: 1255565628
Provider Name (Legal Business Name): HOLLY METZGER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 N CABLE RD
LIMA OH
45805-1704
US

IV. Provider business mailing address

1240 W MARKET ST
LIMA OH
45805-2766
US

V. Phone/Fax

Practice location:
  • Phone: 614-334-6903
  • Fax:
Mailing address:
  • Phone: 567-376-9235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0009767
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: