Provider Demographics
NPI:1164530648
Name:CANTRELL, MARCIA L (LCSW)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 NW WASHINGTON BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013
Mailing Address - Country:US
Mailing Address - Phone:513-869-7000
Mailing Address - Fax:513-785-4272
Practice Address - Street 1:2300 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1221
Practice Address - Country:US
Practice Address - Phone:765-939-2395
Practice Address - Fax:765-939-2425
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0008612104100000X
IN34007899A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW22591Medicare ID - Type Unspecified