Provider Demographics
NPI:1326361841
Name:STACEY DOLEN MSS LISW LLC
Entity Type:Organization
Organization Name:STACEY DOLEN MSS LISW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSS, LISW
Authorized Official - Phone:513-502-8264
Mailing Address - Street 1:7510 KINGSTONVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2495
Mailing Address - Country:US
Mailing Address - Phone:513-502-8264
Mailing Address - Fax:513-233-7340
Practice Address - Street 1:7510 KINGSTONVIEW CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2495
Practice Address - Country:US
Practice Address - Phone:513-502-8264
Practice Address - Fax:513-233-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.08003671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW35391Medicare UPIN