Provider Demographics
NPI:1871008987
Name:FOLEY, JASON (LISW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:FOLEY
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7652 SAWMILL RD STE 311
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9296
Mailing Address - Country:US
Mailing Address - Phone:614-634-2405
Mailing Address - Fax:
Practice Address - Street 1:7243 SAWMILL RD STE 105
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016
Practice Address - Country:US
Practice Address - Phone:614-634-2405
Practice Address - Fax:614-389-3841
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17001081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1871008987Medicaid