Provider Demographics
NPI:1801033667
Name:PFEFFER, IRIS ANN (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:ANN
Last Name:PFEFFER
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 1:1499 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-1075
Mailing Address - Country:US
Mailing Address - Phone:513-737-0545
Mailing Address - Fax:513-737-0545
Practice Address - Street 1:1499 MAIN ST
Practice Address - Street 2:1
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1075
Practice Address - Country:US
Practice Address - Phone:513-737-0545
Practice Address - Fax:513-737-0545
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72591041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH280004Medicare UPIN