Provider Demographics
NPI:1154088219
Name:TAITE, MIREY L'NISE
Entity Type:Individual
Prefix:
First Name:MIREY
Middle Name:L'NISE
Last Name:TAITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-3829
Mailing Address - Country:US
Mailing Address - Phone:513-202-4095
Mailing Address - Fax:
Practice Address - Street 1:2300 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-3829
Practice Address - Country:US
Practice Address - Phone:513-202-4095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker