Provider Demographics
NPI:1114011533
Name:SHORT, CHARLOTTE SAWYER (MSSW,LISW)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:SAWYER
Last Name:SHORT
Suffix:
Gender:F
Credentials:MSSW,LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11385 MONTGOMERY RD
Mailing Address - Street 2:STE 230
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249
Mailing Address - Country:US
Mailing Address - Phone:513-469-6226
Mailing Address - Fax:513-469-6277
Practice Address - Street 1:11385 MONTGOMERY RD
Practice Address - Street 2:STE 230
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249
Practice Address - Country:US
Practice Address - Phone:513-469-6226
Practice Address - Fax:513-469-6277
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00I21001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11590OtherMANAGED HEALTH NETWORK
OH11590OtherMANAGED HEALTH NETWORK