Provider Demographics
NPI:1851056139
Name:KASEY CLIFFTON, LISW-S, LLC
Entity Type:Organization
Organization Name:KASEY CLIFFTON, LISW-S, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING LEAD
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-796-0344
Mailing Address - Street 1:250 E WILSON BRIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2374
Mailing Address - Country:US
Mailing Address - Phone:614-796-0344
Mailing Address - Fax:
Practice Address - Street 1:5025 PINE CREEK DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4849
Practice Address - Country:US
Practice Address - Phone:614-557-6119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0222695Medicaid