Provider Demographics
NPI:1871505115
Name:KARACIA, CISTY JANE (MSSW, LISW)
Entity Type:Individual
Prefix:
First Name:CISTY
Middle Name:JANE
Last Name:KARACIA
Suffix:
Gender:F
Credentials:MSSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 IRONGATE PARK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4616
Mailing Address - Country:US
Mailing Address - Phone:937-436-1600
Mailing Address - Fax:937-436-2467
Practice Address - Street 1:23 IRONGATE PARK DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45459-4616
Practice Address - Country:US
Practice Address - Phone:937-436-1600
Practice Address - Fax:937-436-2467
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00060571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000019121OtherANTHEM
OHNK728OtherEMPIRE BC/BS
OH000000019121OtherANTHEM BENEFIT ADMINISTRA
OH6274245OtherUNITEDBEHAVIORALHEALTH
OH6280813OtherUNITEDHEALTHCARE
OH3114096635001OtherTRIGON BC/BS
OHD6057MOtherTRIHEALTH CLAIMS ADMINIST
OH115663OtherCOMPSYCH
OH4388674OtherAETNA
OH246674OtherMHN
OH9412949OtherPHCS
OH4388674OtherAETNA