Provider Demographics
NPI:1609566876
Name:DWIRE, MARY (MSW, LSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DWIRE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6484 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8139
Mailing Address - Country:US
Mailing Address - Phone:513-207-8020
Mailing Address - Fax:513-000-0000
Practice Address - Street 1:10999 REED HARTMAN HIGHWAY
Practice Address - Street 2:SUITE 207
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-8301
Practice Address - Country:US
Practice Address - Phone:513-999-5506
Practice Address - Fax:513-909-2610
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0019626104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0040456Medicaid