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General NPI Number Information
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NPI Number | 1700300340
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Entity Type | Individual
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Provider Name | CARLY VOLLMAN LISW
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Gender | Female
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Dates
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Enumeration Date | 07/26/2017
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 3333 BURNET AVE. MLC 3014
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City | CINCINNATI
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State | OH
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Zip | 45229
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Country | US
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Telephone | 513-636-4788
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 BURNET AVE. MLC 3014
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City | CINCINNATI
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State | OH
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Zip | 45229
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Country | US
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Telephone | 513-636-4788
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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 | 1600849
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License Number State |
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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.1901543
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | I.1901543-SUPV
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License Number State | OH
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