Provider Demographics
NPI:1699032144
Name:NYERGES, MARISA (LISW-S)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:NYERGES
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-3309
Mailing Address - Country:US
Mailing Address - Phone:513-636-4788
Mailing Address - Fax:513-636-4283
Practice Address - Street 1:6207 DRAKE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-3309
Practice Address - Country:US
Practice Address - Phone:513-636-4788
Practice Address - Fax:513-636-4283
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1100031104100000X
OHI.1600319-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker