MEDICARE: MRS. TINA MARIE CADAVID 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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	I.1000048-SUPV	OH

General Provider Information

NPI Number	:	1336370469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TINA MARIE CADAVID LISW-S

Provider Business Mailing Address
First Line	:	5322 PANTHER CT
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-4200
Country	:	US
Telephone Number	:	513-460-9533
Fax Number	:

Provider Business Practice Location Address
First Line	:	822 DELTA AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45226-1256
Country	:	US
Telephone Number	:	513-460-9533
Fax Number	:

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

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	08/12/2020

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