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NPI Code Detail

MEDICARE: KIYANA KERSHAW SW-T

MEDICARE: KIYANA KERSHAW SW-T
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2104100000XSocial WorkerS.1900858-TRNEOH

General Provider Information

NPI Number : 1598257370
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIYANA KERSHAW SW-T
Provider Business Mailing Address
First Line : 3519 WOODBINE AVE APT 9
Second Line :
City : CINCINNATI
State : OH
Zip : 45211-4831
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5122 GLENCROSSING WAY
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-3361
Country : US
Telephone Number : 513-832-1332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2018
Last Update Date : 08/16/2019

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Directions to “ KIYANA KERSHAW SW-T” Practice Location

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