MEDICARE: MRS. MARIANA FREESE MSW, 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	34008101A	IN
2	1041C0700X	Clinical Social Worker	I.1901539	OH
3	104100000X	Social Worker	I.1901539-SUPV	OH

General Provider Information

NPI Number	:	1538548623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIANA FREESE MSW, LISW

Provider Business Mailing Address
First Line	:	3333 BURNET AVENUE
Second Line	:	MLC 3014
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3026
Country	:	US
Telephone Number	:	513-636-4788
Fax Number	:	513-517-0860

Provider Business Practice Location Address
First Line	:	2030 FAIRFAX AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45207-1943
Country	:	US
Telephone Number	:	513-363-7800
Fax Number	:	513-363-7820

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

Provider Enumeration Date	:	05/22/2015
Last Update Date	:	12/13/2024

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