1164454898 NPI number — AMY THOMAS LISW, LCSW

Table of content: AMY THOMAS LISW, LCSW (NPI 1164454898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164454898 NPI number — AMY THOMAS LISW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
AMY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LISW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164454898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7000 HOUSTON RD
Provider Second Line Business Mailing Address:
SUITE 29
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41042-4873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-746-9272
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 COMPTON RD UNIT 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45231-3846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-746-9272
Provider Business Practice Location Address Fax Number:
513-521-3175
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 184607 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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