MEDICARE: SHANE MICHAEL SATTERFIELD MSW, LSW, LICDC

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	S.1700057	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.162128	OH

General Provider Information

NPI Number	:	1437632759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE MICHAEL SATTERFIELD MSW, LSW, LICDC

Provider Business Mailing Address
First Line	:	3153 SOVEREIGN DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-3160
Country	:	US
Telephone Number	:	513-410-8142
Fax Number	:	513-407-6918

Provider Business Practice Location Address
First Line	:	3153 SOVEREIGN DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-3160
Country	:	US
Telephone Number	:	513-410-8142
Fax Number	:	513-407-6918

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

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	02/05/2023

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