Healthcare Provider Details

I. General information

NPI: 1598547465
Provider Name (Legal Business Name): KATHERINE KURNICK LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6370 S MASON MONTGOMERY RD
MASON OH
45040-3714
US

IV. Provider business mailing address

6370 S MASON MONTGOMERY RD
MASON OH
45040-3714
US

V. Phone/Fax

Practice location:
  • Phone: 513-398-9035
  • Fax: 513-459-0904
Mailing address:
  • Phone: 513-398-9035
  • Fax: 513-459-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2608266
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: