MEDICARE: MR. ANDREW MADISON WINTERS LISWS

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.0009843-SUPV	OH

General Provider Information

NPI Number	:	1396048161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW MADISON WINTERS LISWS

Provider Business Mailing Address
First Line	:	330 PARK AVE
Second Line	:
City	:	NEWPORT
State	:	KY
Zip	:	41071-4577
Country	:	US
Telephone Number	:	513-675-3833
Fax Number	:	513-651-2310

Provider Business Practice Location Address
First Line	:	1026 DELTA AVE STE A
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-3164
Country	:	US
Telephone Number	:	513-675-3833
Fax Number	:	513-651-2310

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

Provider Enumeration Date	:	12/16/2010
Last Update Date	:	12/16/2010

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