Provider Demographics
NPI:1770677718
Name:VERSCHOORE, ANNA L (MSW, LISW)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:L
Last Name:VERSCHOORE
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S 2ND ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-2837
Mailing Address - Country:US
Mailing Address - Phone:937-866-0031
Mailing Address - Fax:937-866-0044
Practice Address - Street 1:110 S 2ND ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-2837
Practice Address - Country:US
Practice Address - Phone:937-866-0031
Practice Address - Fax:937-866-0044
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00095321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMI9346791Medicare NSC