Healthcare Provider Details

I. General information

NPI: 1396772802
Provider Name (Legal Business Name): PAUL KIRGIS LISW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 READING RD
MASON OH
45040-1666
US

IV. Provider business mailing address

975 KINGSVIEW DRIVE SUITE 400
LEBANON OH
45036-8336
US

V. Phone/Fax

Practice location:
  • Phone: 513-398-2551
  • Fax: 513-459-7300
Mailing address:
  • Phone: 513-228-7854
  • Fax: 513-228-7848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-10035-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: