Provider Demographics
NPI:1508476987
Name:DELORD, MARIE CHRISTINE (LSW)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CHRISTINE
Last Name:DELORD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 GRANDIN PASS CT
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8428
Mailing Address - Country:US
Mailing Address - Phone:513-310-0959
Mailing Address - Fax:
Practice Address - Street 1:4641 BACH LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-1900
Practice Address - Country:US
Practice Address - Phone:513-310-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1903687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health