Provider Demographics
NPI:1609455500
Name:LUNGELOW, LISHA INEZ (LSW)
Entity type:Individual
Prefix:
First Name:LISHA
Middle Name:INEZ
Last Name:LUNGELOW
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2409
Mailing Address - Country:US
Mailing Address - Phone:513-256-9062
Mailing Address - Fax:
Practice Address - Street 1:3623 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2409
Practice Address - Country:US
Practice Address - Phone:513-256-9062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802063104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty