MEDICARE: YVONNE PEAY 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	101YM0800X	Mental Health Counselor
2	101YP1600X	Pastoral Counselor
3	104100000X	Social Worker	S-0025130	OH
4	104100000X	Social Worker	S.0025130	OH

General Provider Information

NPI Number	:	1598857724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE PEAY LSW

Provider Business Mailing Address
First Line	:	111 GARFIELD PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1946
Country	:	US
Telephone Number	:	513-510-2148
Fax Number	:

Provider Business Practice Location Address
First Line	:	3012 GLENMORE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2269
Country	:	US
Telephone Number	:	513-914-1815
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	02/27/2023

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