Provider Demographics
NPI:1629375472
Name:BAMBACH, MARTINA (LISW)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:BAMBACH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:2600 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1711
Mailing Address - Country:US
Mailing Address - Phone:513-751-7747
Mailing Address - Fax:513-751-0180
Practice Address - Street 1:7162 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3838
Practice Address - Country:US
Practice Address - Phone:513-761-6222
Practice Address - Fax:513-751-0180
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.1303404OtherLICENSE