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General NPI Number Information
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NPI Number | 1316388663
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Entity Type | Individual
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Provider Name | MARK ENDERLE LSW
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Gender | Male
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 447 E BROADWAY ST
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City | COVINGTON
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State | OH
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Zip | 45318
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Country | US
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Telephone | 937-473-2031
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Fax |
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Provider Business Mailing Address
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Address Line | 447 E BROADWAY ST
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City | COVINGTON
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State | OH
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Zip | 45318
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Country | US
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Telephone | 937-473-2031
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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 | S.0031212
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License Number State | OH
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