Provider Demographics
NPI:1326383647
Name:DEJARNETTE, LISA R (LISW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:DEJARNETTE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 HOSBROOK RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2901
Mailing Address - Country:US
Mailing Address - Phone:513-861-9797
Mailing Address - Fax:513-861-3510
Practice Address - Street 1:8040 HOSBROOK RD
Practice Address - Street 2:SUITE 320
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2901
Practice Address - Country:US
Practice Address - Phone:513-861-9797
Practice Address - Fax:513-861-3510
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI08000081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI0800008OtherSOCIAL WORK LICENSE