Provider Demographics
NPI:1164741773
Name:MANN, KARIE L (LISW)
Entity Type:Individual
Prefix:
First Name:KARIE
Middle Name:L
Last Name:MANN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 PARKWAY CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2601
Mailing Address - Country:US
Mailing Address - Phone:937-401-0055
Mailing Address - Fax:937-853-3020
Practice Address - Street 1:1330 PARKWAY CT
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2601
Practice Address - Country:US
Practice Address - Phone:937-401-0055
Practice Address - Fax:937-853-3020
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI09001551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical