Provider Demographics
NPI:1689111528
Name:STREIFF, KATHRYN L (LISW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:STREIFF
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 1:1131 CENTRAL AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4006
Mailing Address - Country:US
Mailing Address - Phone:513-393-7710
Mailing Address - Fax:
Practice Address - Street 1:1131 CENTRAL AVE STE 204
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4006
Practice Address - Country:US
Practice Address - Phone:513-393-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17005031041C0700X
OHS.1500632104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01-0693OtherCARF CERTIFICATION
OH0074946OtherMEDICAID-ODMH
OHH130910OtherMEDICARE GROUP PTAN
OH0074861OtherMEDICAID-ODADAS