Provider Demographics
NPI:1780219477
Name:PEAK, EBONY (LISW)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:PEAK
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 1:7373 BROOKCREST DR STE 305
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-3455
Mailing Address - Country:US
Mailing Address - Phone:513-570-4068
Mailing Address - Fax:513-672-1028
Practice Address - Street 1:7373 BROOKCREST DR STE 305
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3455
Practice Address - Country:US
Practice Address - Phone:513-445-2053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.19017761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty