=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497037246
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL R MYERS M.S.W.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2011
-----------------------------------------------------
Last Update Date | 01/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8040 HOSBROOK RD SUITE 310
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45236-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-426-3290
-----------------------------------------------------
Fax | 513-672-0053
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8040 HOSBROOK RD SUITE 310
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45236-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-426-3290
-----------------------------------------------------
Fax | 513-672-0053
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | I.1000212.SUPV.
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------