MEDICARE: ANGELA J UPTON 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	104100000X	Social Worker	1-0004906	OH

General Provider Information

NPI Number	:	1861573180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA J UPTON LISW

Provider Business Mailing Address
First Line	:	5642 HAMILTON AVE
Second Line	:	ML 6015
City	:	CINCINNATI
State	:	OH
Zip	:	45224-3114
Country	:	US
Telephone Number	:	513-636-0847
Fax Number	:	513-636-0081

Provider Business Practice Location Address
First Line	:	4030 MOUNT CARMEL TOBASCO RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-3400
Country	:	US
Telephone Number	:	513-528-9200
Fax Number	:	513-870-0818

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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