Healthcare Provider Details

I. General information

NPI: 1821588005
Provider Name (Legal Business Name): CASSY LEE LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S SOUTH ST
WILMINGTON OH
45177-2755
US

IV. Provider business mailing address

658 MADISON PL
GREENFIELD OH
45123-1040
US

V. Phone/Fax

Practice location:
  • Phone: 866-534-2639
  • Fax: 800-480-7578
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2405634
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: