Provider Demographics
NPI:1639738107
Name:FLEMING, MARY-ELLEN JOAN (LSW)
Entity Type:Individual
Prefix:
First Name:MARY-ELLEN
Middle Name:JOAN
Last Name:FLEMING
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 1:44 WHIPKEY DR
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9648
Mailing Address - Country:US
Mailing Address - Phone:614-937-0371
Mailing Address - Fax:
Practice Address - Street 1:175 S 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5194
Practice Address - Country:US
Practice Address - Phone:614-937-0371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker