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NPI Code Detail

MEDICARE: MR. DOUGLAS CONLEY LISW

MEDICARE: MR. DOUGLAS CONLEY 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
11041C0700XClinical Social WorkerI-0001527OH

General Provider Information

NPI Number : 1518189364
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS CONLEY LISW
Provider Business Mailing Address
First Line : 2415 AUBURN AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-2701
Country : US
Telephone Number : 513-221-4949
Fax Number : 513-241-4191
Provider Business Practice Location Address
First Line : 2805 GILBERT AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45206-1210
Country : US
Telephone Number : 513-281-4116
Fax Number : 513-281-1492
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 09/27/2011

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