Provider Demographics
NPI:1821452962
Name:HUMBERT, JENNIFER M (LSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:M
Last Name:HUMBERT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-4821
Mailing Address - Country:US
Mailing Address - Phone:513-739-2105
Mailing Address - Fax:
Practice Address - Street 1:3902 TAFT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-4821
Practice Address - Country:US
Practice Address - Phone:513-739-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 1200305104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker