MEDICARE: SARAH M HEADLEY LSW

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.0800552	OH

General Provider Information

NPI Number	:	1578704946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH M HEADLEY LSW

Provider Business Mailing Address
First Line	:	2600 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1711
Country	:	US
Telephone Number	:	513-853-6576
Fax Number	:

Provider Business Practice Location Address
First Line	:	4968 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3902
Country	:	US
Telephone Number	:	513-853-6576
Fax Number	:

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

Provider Enumeration Date	:	03/16/2009
Last Update Date	:	03/16/2009

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