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General NPI Number Information
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NPI Number | 1265634778
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Entity Type | Individual
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Provider Name | SCOTT ANTHONY NICOLA LISW
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Gender | Male
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 8140 LEWIS CENTER RD
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City | WESTERVILLE
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State | OH
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Zip | 43082-9415
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Country | US
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Telephone | 614-507-6545
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Fax |
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Provider Business Mailing Address
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Address Line | 8140 LEWIS CENTER RD
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City | WESTERVILLE
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State | OH
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Zip | 43082-9415
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Country | US
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Telephone | 614-507-6545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | I0027071
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License Number State | OH
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