Healthcare Provider Details

I. General information

NPI: 1033503628
Provider Name (Legal Business Name): LISA ZITO LISW-S, CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 E KEMPER RD STE 4220A
SPRINGDALE OH
45246-5100
US

IV. Provider business mailing address

1329 E KEMPER RD STE 4220A
SPRINGDALE OH
45246-5100
US

V. Phone/Fax

Practice location:
  • Phone: 513-970-9522
  • Fax: 513-436-0687
Mailing address:
  • Phone: 513-970-9522
  • Fax: 513-436-0687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.1700466
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1700466
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1700466-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: