Provider Demographics
NPI:1568561009
Name:GEORGE, JANICE B (LISW)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:B
Last Name:GEORGE
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 1:1320 KING AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2221
Mailing Address - Country:US
Mailing Address - Phone:614-487-0358
Mailing Address - Fax:614-481-2174
Practice Address - Street 1:1320 KING AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2221
Practice Address - Country:US
Practice Address - Phone:614-487-0358
Practice Address - Fax:614-481-2174
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH160171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000115760OtherANTHEM
OH4277398OtherAETNA
OH13328500OtherMAGELLAN MIS#
OH4277398OtherAETNA
OHR72140Medicare UPIN