Provider Demographics
NPI:1437685351
Name:MAHAN, AMY J (LISW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:MAHAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML6019
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229
Mailing Address - Country:US
Mailing Address - Phone:513-636-5278
Mailing Address - Fax:866-456-5794
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML6019
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-5278
Practice Address - Fax:866-456-5794
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17002991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical