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General NPI Number Information
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NPI Number | 1407300916
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Entity Type | Individual
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Provider Name | EMILY J FUMAROLA LISW
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Gender | Female
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Dates
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Enumeration Date | 08/12/2016
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 10921 REED HARTMAN HWY STE 133
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City | BLUE ASH
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State | OH
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Zip | 45242-2851
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Country | US
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Telephone | 513-984-9838
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 S STATE ROUTE 133
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City | BLANCHESTER
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State | OH
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Zip | 45107-8483
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Country | US
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Telephone | 937-728-7707
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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.1600556
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.2002203
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License Number State | OH
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