MEDICARE: LAINEY GRAHAM LISW-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I.2102723	OH

General Provider Information

NPI Number	:	1285134221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAINEY GRAHAM LISW-S

Provider Business Mailing Address
First Line	:	3113 CLIFTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-2404
Country	:	US
Telephone Number	:	513-766-3320
Fax Number	:

Provider Business Practice Location Address
First Line	:	3113 CLIFTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-2404
Country	:	US
Telephone Number	:	513-766-3320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2018
Last Update Date	:	07/31/2024

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