MEDICARE: KELLY LUCILLE LUMBERT LISW

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.2507561	OH

General Provider Information

NPI Number	:	1457045635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LUCILLE LUMBERT LISW

Provider Business Mailing Address
First Line	:	3421 MIDDLETON AVE APT 6
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-1620
Country	:	US
Telephone Number	:	513-668-7040
Fax Number	:

Provider Business Practice Location Address
First Line	:	8040 HOSBROOK RD STE 320
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2908
Country	:	US
Telephone Number	:	513-939-0300
Fax Number	:

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

Provider Enumeration Date	:	06/08/2023
Last Update Date	:	12/16/2025

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